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: https://molina.sapphirethreesixtyfive.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 2024:

  • Existing Molina States: Arizona, California, Idaho, Illinois, Michigan, Nevada, Ohio, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin
  • Service Area Expansions:     
    • 8 New Counties in Michigan
    • 39 New Counties in Illinois
    • Partial to Full County Expansions in California (Los Angeles, Riverside, San Bernardino, San Diego, and Imperial)
  • New Plan/Plan Segmentations/Member Crosswalks:
    • California H5810-001 plan members will crosswalk to H3038-001
    • California H5810-013 plan members will crosswalk to H3038-002
    • California H5810-016 plan members will crosswalk to H3038-003
    • Washington H5823-011 plan members will crosswalk to H5823-012-001 or H5823-012-002, based on county
  • Plan Sunsets:
    •  We will not be offering Medicare Advantage plans in Florida and New Mexico in 2024
    • Arizona - Molina Medicare Choice Care Select (HMO)
    • Nevada - Molina Medicare Choice Care Select (HMO)
    • Texas - Molina Medicare Comfort Care (HMO I-SNP)

Effective January 1, 2025, the Molina and My Choice Wisconsin Medicare products will be combined. Read more.

Provider Manuals

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Dental Provider Manuals

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Forms

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EDI/ERA/EFT

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Prior Authorization Forms

Medical, BH, Pharmacy

Prior Authorization Code Look-up Tool
2024 Medicare PA Guide
2024 Medicare PA Form
2024 Medicare BH PA Form
2024 Medicare Pharmacy PA Form

2024 PA Code Matrices & Forms

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2023 PA Code Matrices & Forms
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Archive PA Code Matrices & Forms

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Pharmacy PA Criteria

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Guidelines

Clinical Practice Guidelines
Preventive Health Guidelines
Provider Portal User Guide
MCG Cite AutoAuth Provider Access Quick Resource Guide


Model of Care

Model of Care Provider Training Quick Reference Guide
2024 Model of Care Provider Training 

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2025 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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Formulary

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Policies

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

Payment Integrity Policies

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Services

Medication Therapy Management
Case Management
Disease Management 
Health Promotion
Nurse Advice
Smoking Cessation Resources

Care for Diverse Populations

Industry Collaborative Effort (ICE) – Better Communication, Better Care

    Communications

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    Rx Forms

    How to Request a Redetermination

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    Redetermination Form

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    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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    Skilled Nursing Facility

    EMU Post Acute Clinical Request Form
    2017 Nursing Facility Provider

    Non-Contracted Providers

    Non-Contracted Provider Dispute and Appeals Processes
    Waiver of Liability