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

Go

Forms

Go 

EDI/ERA/EFT

Go

Prior Authorization Forms

Medical, BH, Pharmacy

Go
Go
Go

PA Criteria

Go

Guidelines

Clinical Practice Guidelines
Provider Portal User Guide

Go

Model of Care

2022 Model of Care Provider Training Quick Reference Guide
2022 Model of Care Provider Training 

Go

Health Resources

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

HEDIS/CAHPS

Go

Formulary

Go

Policies

Member Rights & Responsibilities
Provider Rights & Responsibilities
Advance Directives
Credentialing Rights
Fraud Prevention
Patient Safety
In Office Laboratory Tests

Payment Integrity Policies

Go

Communications

Go
 

Rx Forms

How to Request a Redetermination

Go

Redetermination Form

Go

Pharmacy Direct Member Reimbursement Form

Go

Medicare Compliance Program

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

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

Go

Medicare Compliance Training

Go