Welcome Molina Medicare Providers!

It is important to Molina Healthcare and your patients that your provider directory demographics are accurate. Please visit our Provider Online Directory at: providersearch.molinahealthcare.com to validate your information and notify us if there are any updates.

Please notify Molina Healthcare at least 30 days in advance when you have any of the following:

  • Change in office location, office hours, phone, fax, or email
  • Addition or closure of office location
  • Addition or termination of a provider
  • Change in Tax ID and/or NPI
  • Open or close your practice to new patients (PCPs only)

Changes for 2022:

Medicare 2022 expansion includes: 

  • Plan Expansions:
    • SNP: (10) new plan offerings in Florida, Idaho, Michigan, Utah, Washington, New York, and Texas
    • MAPD: (17) new plan offerings in Texas, Washington, California, Florida, Utah, and New Mexico
  • Service Area Expansions: 83 new counties in (8) existing Molina states and (2) new states
    • Existing Molina states: Florida, Michigan, New Mexico, Ohio, South Carolina, Texas, Washington, and Wisconsin
    • New states: Kentucky and Massachusetts
    *     Note: Illinois MMP SAE of 87 new counties statewide as of 07/01/2021
  • Plan Consolidations: Michigan H5926-004 will consolidate into H5926-001
  • Plan Exits: Ohio H8176-002 members will crosswalk to Ohio H9955-001
  • Plan Acquisitions: Kentucky (1), Arizona (1), Virginia (1), Massachusetts (2), and New York (1)
     

Provider Manuals

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Forms

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EDI/ERA/EFT

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Prior Authorization Forms

Medical

2021 Q4 PA Code Matrix – All Medicare States
2021 Q3 PA Code Matrix – All Medicare States
CA – Behavioral Health Prior Authorization Form
CA – Behavioral Health Therapy Prior Authorization Form (Autism)
CA – Q3 2021 PA Code Matrix
CA – Q2 2021 PA Code Matrix
CA – Q1 2021 PA Code Matrix
CA – 2021 Prior Authorization Guide
CA – 2020 Prior Authorization Guide v2
CA – 2020 Prior Authorization Guide
FL – 2021 PA Code Matrix (Effective 04/01/2021)
FL – 2020 Prior Authorization/Pre-Service Review Guide
FL – In-Office Tests List (Effective 01/01/18)
ID – 2021 Medicare Prior Authorization Guide
ID – 2021 PA Code Matrix Medicare
MI – Q3 2021 PA Guide – Medicare (Effective 07/01/2021)
MI – Q3 2021 PA Matrix (Effective 07/01/2021)
MI – Q3 2021 PA Guide – Medicaid & Marketplace (Effective 07/01/2021)
MI – Q2 2021 PA Guide (Effective 4/1/2021)
MI – Q2 2021 PA Code Matrix (Effective 4/1/2021)
NM – 2021 Q2 Prior Authorization Code Matrix
NM – 2021 Q1 Prior Authorization Code list
NM – 2021 Prior Authorization Guide and Form
NM – Facet Joint Injections Form Medicare
OH – Prior Authorization Request Form
OH – 2021 Q2 Prior Authorization Code Matrix
SC – 2021 Prior Authorization Guide
SC – 2021 Q2 Prior Authorization Matrix
SC – 2021 Prior Authorization Request Form
SC – 2020 BH Prior Authorization Form
TX – Behavioral Health Service Request Form
TX – 2021 Q2 Prior Authorization Code Matrix
TX – 2021 Prior Authorization Guide
UT – 2021 Prior Authorization Guide
UT – 2021 Prior Authorization Code Matrix
WA – 2021 Prior Authorization Guide Form
WA – 2021 Prior Authorization Code Matrix
WI – Q4 2021 Code Matrix
WI – Q3 2021 Code Matrix
WI – Q4 2021 PA Request Form

Rx

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Guidelines

Clinical Practice Guidelines
Provider Portal User Guide

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Model of Care

2021 Model of Care Provider Training Quick Reference Guide
2021 Model of Care Provider Training 

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Health Resources

Behavioral Health Toolkit
Culturally and Linguistically Appropriate Resources
Medical Record Standards
Quality Improvement
Home Care FAQ

HEDIS/CAHPS

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Communications

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Rx Forms

How to Request a Redetermination

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Redetermination Form

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Pharmacy Direct Member Reimbursement Form

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Medicare Compliance Program

The Molina Compliance Hotline:
Ph: 866-606-3889

To report an issue online visit: https://molinahealthcare.AlertLine.com

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Medicare Compliance Training

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