Contracted providers are an essential part of delivering quality care to our members. We value our partnership and appreciate the family-like relationship that you pass on to our members.

As our partner, assisting you is one of our highest priorities. We welcome your feedback and look forward to supporting all your efforts to provide quality care.

If you have any questions, please call Provider Services at 1-855-322-4076.

 

Need a Prior Authorization?

* When Prior Authorization is 'Required', click here to create Service Request/Authorization

PA Lookup tool is under maintenance.

Please refer to the state specific Excel matrix while the PA Lookup Tool is disabled.

Attention:

For the Molina Specialty Plan

Claims date of services rendered on 9/1/21 and forward, please visit the Availity Provider portal at: www.availity.com.

For claims date of services 8/31/21 and prior, please visit the Magellan Complete Care portal at: www.magellancompletecareoffl.com.

Florida Providers: Claims submitted  with dates of service prior to 8/31/21 must be submitted with the Magellan Payor ID.  Claims submitted with the Molina Payor ID will be rejected or denied.

The MCC Portal will only be available for the following services:

  • Claim submissions
  • Claim status
  • Web Checks
  • View your Explanation of Payment (EOP)

If you need assistance with other information, please call the Molina Provider Contact Center at: 1-855-322-4076 or TYY at 711

Electronic Medical Records Access

Molina Healthcare strives to improve HEDIS scores year-round through the collection and reporting of data. To achieve high HEDIS scores, the collection of medical records must occur multiple times throughout the year. Molina is interested in strengthening our relationship with provider groups by utilizing EMR Remote Access method to efficiently retrieve the necessary records to meet HEDIS requirements.

Benefits from EMR Remote Access:

  • Reduction in time and office resources
  • Removing the need for multiple outreaches from our team to yours
  • Mitigating COVID-19 risks associated with going on-site

In order to fulfill our state and federal accreditation requirements regarding HEDIS and Risk Adjustment quality reporting, it is necessary for Molina to collect medical record data year-round.

By providing Molina Remote Access to HEDIS data, Molina can simplify the record collection process for the office staff. EMR access ensures Molina receives the required records in a timely manner to properly obtain HEDIS and contract compliance for the selected members.

We are striving for a collaborative relationship; therefore, your Intervention specialist is readily available to offer any help. You can also reach out to a HEDIS Specialist at: RegionDHEDIS@MolinaHealthCare.Com.

Molina Healthcare Upcoming Training Schedule

Come join us and learn more about Molina Healthcare's New Specialty Plan!!

 

If you would like to attend any of these Training Dates, please RSVP to MFLProviderNetworkManagement@Molinahealthcare.com and click on the date for Login information.

PLEASE CHECK BACK FOR MORE TRAINING DATES!!!

 

Submitting Disputes via the Portal to Stop the Spread of COVID-19

Molina Healthcare takes the health of our members, providers, and employees alike, very seriously. As we are aware, COVID-19, more commonly known as Coronavirus is of the utmost concern globally. We do know that COVID-19 is an airborne virus that can be spread when someone coughs, sneezes or talks.

For any providers who need to submit any dispute, please submit via the Provider Web Portal. For detailed instructions on how to submit a dispute, please review the Web Portal Quick Reference Guide located on our website at www.MolinaHealthcare.com or on the web portal under the "Training" link.

Submitting disputes through the portal will reduce the spread of the virus by alleviating the risk of handling potentially contaminated documents as well as improved efficiency and reduced cost to the provider.

Please take the necessary precautions to ensure that you, your staff, and patients remain healthy and help us remain vigilant to curb the spread of this virus.

If you have questions, please contact Molina Healthcare at: 855-322-4076

Claims Denied for Missing Documentation

Claims denied for missing or additional documentation requirements such as consent forms, invoices, Explanation of Benefits from primary carrier, or itemized bills are not considered claim disputes. In order to process your claim appropriately and promptly, these documents, along with a copy of the claim, must be received within federal and state timely filing requirements and/or your Provider Services Agreement. Please mail the documentation with the copy of the claim to:

Molina Healthcare of FL
P.O. BOX 22812
Long Beach, CA 90801

Please Note: As of January 15, 2020, disputes received for denial reasons stated above will be rejected.

ATTENTION PROVIDERS!!!

Providers should use QUEST DIAGNOSTICS, our preferred provider for laboratory services when referring members for lab services not covered in the office.

Claims for tests performed at non-par labs without prior authorization will be denied. Medically necessary laboratory services ordered by a PCP or other care provider performed at Quest typically DO NOT require prior authorization (except as noted on our prior authorization list.)

In-Office Labs
Molina allows only certain laboratory tests in the physician’s office. All other medically necessary laboratory testing must be directed to an in-network Laboratory such as Quest Diagnostics by the ordering physician (i.e.: specimens dropped in the Quest box for pick-up). For a list of approved in-office laboratory tests, including tests such as Rapid Strep, visit the “Forms” link above, and click on “In-Office Tests List”.

Claims for lab tests performed in the physician office, but NOT on Molina’s list of allowed in-office or otherwise authorized, may be denied payment.

For the latest list of patient services centers (draw sites), please reach out to Quest Diagnostics or view Molina’s Online Provider Directory.

Quest Diagnostics
866-MYQUEST (866-697-8378)
www.questdiagnostics.com

Important Reminder:

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)