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Use our Online Provider Directory to find a physician or other health care professional for you or your family members.

When should I go to the emergency room?
Sometimes it can be hard to know if a health problem is a medical emergency. The below information will help you determine if you need to go to the emergency room or if you can wait for an appointment with your primary care provider (PCP).

What is an emergency?
An emergency is a sudden or unexpected illness, severe pain, accident, or injury that could cause serious injury or death if it is not treated immediately. If you are having an emergency, don’t wait! Contact 911 or go to the emergency room right away.

Contact 911 or go to the ER for:

• Trouble breathing
• Chest pains
• Heavy bleeding
• Coughing or vomiting blood
• Serious burn
• Signs of stroke
• - Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body
• - Sudden confusion, trouble speaking, or difficulty understanding speech
• - Sudden trouble seeing in one or both eyes
• - Sudden trouble walking, dizziness, loss of balance, or lack of coordination
• - Sudden severe headache with no known cause
• Severe allergic reaction
• Suicidal or homicidal feelings
• Confusion of change in mental state
• Broken bone
• High fever (105 degrees F)
• Fainting
• Swallowing of obstructive object (coins, magnets, small toy parts)
• Major head injury
• Palpitations
• Uncontrollable shaking
• Seizures
  
  

There are some treatments, services and drugs that require approval from us before you can get them. This is called a prior authorization. You or your doctor can ask for a prior authorization. Contact Member Services to ask if a service or treatment needs a prior authorization.
After you or your doctor asks us for a prior authorization, we review the request to decide if the treatment is medically needed and right for you. We will let you know if the request is approved within 14 calendar days. If waiting more than 14 days could seriously harm your health, your doctor can ask us to do an expedited review. If your doctor asks for an expedited review, we will let you know if the request is approved within 3 calendar days, or as quickly as your health condition requires.
If you disagree with our decision, you can file an appeal. You can read more about how to do that on this page. Look in your Member Handbook for more information about prior authorizations.

If you have not gotten your Molina Member ID card, or your card is damaged, lost or stolen, you can:

• Go to the My Molina member portal to access it electronically or to print a Molina Member ID card.
• Contact Member Services and ask for a replacement paper card.

You can change your primary care provider (PCP) with Molina at any time. To choose or change your PCP go to the My Molina member portal or contact Member Services.

It is possible that your PCP might leave our network. If this happens, we will tell you within 30 days from when we know about this. We can help you find a new PCP right away.

It is important for you to take your Health Risk Screener. Your answers will help us understand your needs and allow us to provide you with the best level of care. The Health Risk Screener will also assist us in determining if you are a good candidate for case management.

You can complete your Health Risk Screener via the My Molina member portal under the Health Record tab. For additional assistance, you can also contact Member Services at 1-844-782-2018  (TTY: 711), Monday to Friday, 8 a.m. to 6 p.m. CT

Care management is a set of supports to help you access medical, behavioral and/or social services. Care management helps to improve your health and wellness. Examples may include Health Risk Screening, transportation services, health care reminders, and value added-benefits.

Case management is offered to members identified with complex medical conditions, or members who self-identify as homeless or medically complex. Members will have a personal care plan based on their needs. They will have a case manager to help them reach their healthcare goals over a period of time. Members can self-enroll in case management by filling out either of the following two forms :

  MEDICALLY COMPLEX FORM
  HOMELESSNESS IDENTIFICATION FORM

Members who are candidates for case management include, but are not limited to:

• Members with complex medical or behavioral conditions (including substance use disorders),
• Members who have health conditions, including chronic conditions that would benefit from case management,
• Foster members (including members aging out of foster care)
• Members involved in the justice system
• Members with Medicare and Medicaid
• Members with intellectual or developmental disabilities.

You can get rides at no cost to and from your medical, behavioral health, and dental appointments. Rides must be set up at least 72 hours prior to your appointment. You can schedule transportation by:

• Contacting Member Services and requesting transportation assistance
• Contacting MTM directly at 888-889-0421 (TTY:711), Monday-Friday, from 8 a.m. to 7 p.m.
• Using the MTM member portal
• Downloading the MTM Link Member app on your smart device

When you call or use the transportation portal, MTM will ask you:

• The address where you will be picked up. This includes the city and zip code.
• The address where you will be dropped off. This includes the city and zip code.
• Your telephone number
• Your Nebraska Medicaid ID number
• The name of the adult traveling with children aged 18 and under

Transportation can go to the provider you choose within 20 miles. If there is not a provider within 20 miles, they can take you to the closest provider. You can choose a provider farther away, but transportation services may not be available.

You, the member, can file a grievance or appeal. You can also have someone else file your grievance or appeal for you, with your written consent. This is called an Authorized Representative. Your Authorized Representative can be your provider, a relative, friend, and even an attorney.

What is an appeal?
An appeal is a way for you to challenge an adverse benefit determination (a denial or reduction in benefits) made by Molina Healthcare (Molina) if you think we made a mistake. You can ask us to change our decision by filing an appeal.

What is a grievance?
A grievance is a complaint you make about us or one of the providers or pharmacies in the Molina network. This includes a complaint about the quality of your care.

How do I file an appeal?
If you are not satisfied with a decision we made, you have 60 calendar days to file an appeal. You can file the appeal yourself or ask someone to file the appeal for you.

You can file an appeal by phone or in writing. You can send your appeal as a standard appeal or an expedited (fast) request.

Check your Member Handbook for complete instructions on how to file an appeal or grievance.

You can also contact Member Services if you need help filing an appeal or grievance.

Molina Healthcare’s Fraud and Abuse Plan benefits Molina, its employees, members, providers, payers and regulators by increasing efficiency, reducing waste, and improving the quality of services.

Molina Healthcare takes the prevention, detection, and investigation of fraud and abuse seriously, and complies with state and federal laws. Molina Healthcare investigates all suspected cases of fraud and abuse and promptly reports to government agencies when appropriate. Molina Healthcare takes the appropriate disciplinary action, including but not limited to, termination of employment, termination of provider status, and/or termination of membership. You can report potential fraud, waste, and abuse without giving us your name.

To report suspected Medicaid fraud, contact

Molina Healthcare Alert Line at: Toll free, (866) 606-3889
Or
Complete a report form online at: MolinaHealthcare.alertline.com .

You can also alert the state by visiting Reporting Medicaid Fraud (ne.gov).

Definitions:

“Abuse” means provider practices that are inconsistent with sound fiscal, business, or medical practices, and result in unnecessary cost to the Medicaid program or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program. (42 CFR §455.2)

“Fraud” means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit for them or some other person. It includes any act that constitutes fraud under applicable Federal or State law. (42 CFR § 455.2)

Here are some ways you can help stop fraud:

• Don’t give your Molina Healthcare ID card, Medical ID Card, or ID number to anyone other than a health care provider, a clinic, or hospital, and only when receiving care.
• Never let anyone borrow your Molina Healthcare ID Card.
• Never sign a blank insurance form.
• Be careful about giving out your social security number.