Molinalogo

As a healthcare provider who may serve Molina Healthcare members but is not currently in our provider network, we want to ensure you have the information you need for both you and your patients. Knowing Molina Healthcare's procedures is key to a smooth experience in treating our members.

To make things easier for you and your patients, we've gathered essential resources. These resources cover important information for your engagement with Molina Healthcare, such as guidelines, authorization procedures, and necessary protocols.

*Please note that all non-contracted providers need prior authorization before treating our members.

We appreciate your dedication to delivering quality care to patients, including those within the Molina Healthcare network. Your collaboration is invaluable, and we thank you for working together to support the well-being of our members.

Helpful Documents and Links

Contacts

MHC offers three lines of business: Medi-Cal, Medicare, and Marketplace.

Prior Authorization (PA)

Prior authorizations can be initiated by contacting Molina’s Health Care Services department at: (844) 557-8434.

It may be necessary to submit additional documentation before the authorization can be processed. For more information, please refer to the Frequently Used Forms webpage.

Non-Contracting 988 Providers: For Authorization 1) to provide post-stabilization or 2) to transfer a stabilized enrollee's care to another provider, please use the following: 

 Phone: (844) 966-5462

 Fax: (877) 665-4625

For more information on Letter of Agreements (LOAs), please review the MHC LOA step-by-step process.

Transportation

Emergency Medical Transportation

• Emergency transportation (ambulance), or ambulance transport services, provided through the “911” emergency response system, will be covered when medically necessary.

Non-Medical Transportation (NMT)

• NMT is covered for medically necessary covered services. NMT is transportation by a car, taxi, or other public or private way of getting to your medical appointment.

Non-Emergency Medical Transportation (NEMT)

• NEMT is covered for medically necessary covered services. NEMT is transportation by ambulance, litter van, wheelchair van or air.
• A primary care physician or specialist will need to complete a provider certification statement form prior to the member receiving NEMT services. The Physician Certification Statement from can be downloaded at: http://www.molinahealthcare.com/providers/ca/medicaid/forms/Pages/fuf.aspx

Continuity of Care (CoC)

Providers can request CoC by submitting the Continuity of Care Form to MHC. For more information, please refer to MHC’s designated CoC webpage.

Eligibility Verification

Providers are encouraged to register and use the Availity portal as a primary method to check Member’s eligibility information at their convenience. Providers may also verify eligibility by calling the Molina Provider Contact Center’s automated IVR system at (855) 322-4075.

EDI

Please see the EDI FAQ page to learn more about EDI and MHC’s clearinghouse.

Claims

Molina offers the following electronic claims submission options:

• Submit claims directly to Molina via the Availity portal
• Submit claims to Molina via your regular EDI Clearinghouse

For further instructions on claim submission, please refer to:

• Medi-Cal Manual
  • Chapter 22: Claims and Compensation
• Medicare Manual
  • Chapter 13: Claims and Compensation

• Marketplace Manual
  • Chapter 13: Claims and Compensation

Timely Filing

Medi-Cal

For more information on Timely Filing, please refer to Chapter 22: Claims and Compensation in the MHC Medi-Cal Manual.

Medicare

For more information on Timely Filing, please refer to Chapter 13: Claims and Compensation in the MHC Medicare Manual.

Marketplace

For more information on Timely Filing, please refer to Chapter 13: Claims and Compensation in the MHC Marketplace Manual.

Provider Dispute Resolution

The Provider Dispute Resolution unit is responsible for providing a fast, fair, and cost-effective dispute mechanism to process and resolve contracted and non-contracted provider disputes.

Provider disputes can be submitted through:

Mail:

Molina Healthcare of California

P.O. Box 22722

Long Beach, CA 90801

Attn: Provider Dispute Resolution Unit

Electronic:  Availity portal

For more information on Provider Disputes, please refer to: 

Medi-Cal Manual

Chapter 9: Appeals and Grievances/Complaints

Medicare Manual

Chapter 14: Medicare Member Grievances and Appeals

Marketplace Manual

Chapter 14: Complaints, Grievances, and Appeals Process

Interested in joining our Network?

We’re always looking for high-quality providers to help care for our members. Please email our contracting team for more information on how to contract with Molina Healthcare.

• Inland Empire: iecontracting@molinahealthcare.com
• Los Angeles: lacontracting@molinahealthcare.com
• San Diego: mhcsandiegocontracts@molinahealthcare.com
• Sacramento: mhcsacramentocontracts@molinahealthcare.com
• Imperial: mhcimperial.contra@molinahealthcare.com