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 2023:
Medicare 2023 expansion includes:
- Plan Expansions:
- SNP: (5) new plan offerings in California, Nevada, Ohio, Virginia, and Wisconsin
- MAPD: (9) new plan offerings in Arizona, Illinois, Massachusetts, Michigan, Nevada, Ohio, and Virginia
- Service Area Expansions: 136 new counties in (10) existing Molina states and (2) new states
- Existing Molina states: Florida, Idaho, Kentucky, Michigan, New Mexico, New York, Ohio, Texas, Washington, and Wisconsin
- New states: Nevada and Illinois
- Plan Consolidations: Idaho H5628-009 members will crosswalk to Idaho H5628-010; New Mexico H9082-009 members will crosswalk to New Mexico H9082-010
- Plan Sunsets: California MMP (Molina Dual Options Medicare-Medicaid Plan: H8677-001 and H8677-002) plan members will crosswalk to the new Medicare Exclusively Aligned Enrollment plan: Molina Medicare Complete Care Plus (HMO D-SNP) (H5810-016)
Prior Authorization Forms
Medical, BH, Pharmacy
Medicare PA GuideMedicare PA Form
Medicare BH PA Form
Medicare Pharmacy PA Form
PA Criteria
Guidelines
Clinical Practice Guidelines
Provider Portal User Guide
Model of Care
2023 Model of Care Provider Training Quick Reference Guide
2023 Model of Care Provider Training
Health Resources
Behavioral Health Toolkit
Culturally and Linguistically Appropriate Resources
Medical Record Standards
Quality Improvement
Home Care FAQ
HEDIS/CAHPS
Formulary
Policies
Member Rights & Responsibilities
Provider Rights & Responsibilities
Advance Directives
Credentialing Rights
Fraud Prevention
Patient Safety
In Office Laboratory Tests
Payment Integrity Policies
Care for Diverse Populations
Industry Collaborative Effort (ICE) – Better Communication, Better Care
Communications
Medicare Compliance Program
The Molina Compliance Hotline:
Ph: 866-606-3889
To report an issue online visit: https://molinahealthcare.AlertLine.com
Medicare Compliance Training
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