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)
     

Provider Manuals

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Forms

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EDI/ERA/EFT

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Prior Authorization Forms

Medical, BH, Pharmacy

Medicare PA Guide
Medicare PA Form
Medicare BH PA Form
Medicare Pharmacy PA Form
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PA Criteria

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Guidelines

Clinical Practice Guidelines
Provider Portal User Guide

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Model of Care

2023 Model of Care Provider Training Quick Reference Guide
2023 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
    Ohio Nursing Facility and Assisted Living Reference Guide

    Non-Contracted Providers

    Non-Contracted Provider Dispute and Appeals Processes
    Waiver of Liability