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Frequently Asked Questions & Answers (FAQs)
Customer Service
Q: What hours can I call Molina Healthcare TPA Customer Service?
A: The customer service representatives are available to answer your calls from 8 a.m. to 5 p.m. Mountain Time, Monday through Friday. Contact Customer Service at (505) 348-0311 or toll-free at (866) 916-3250.
Q: How can I contact the Molina Healthcare TPA Medical Director?
A: (505) 348-0311 or toll-free at (866) 916-3250.
Q: With regard to ISD 379 forms, will Molina Healthcare TPA only accept 3 cases when providers call in about questions regarding residents?
A: There is not a limit if a provider calls to check status of specific cases.
Q: Can eligibility be verified through Molina Healthcare TPA Customer Service?
A: Molina Healthcare TPA does not provide eligibility information. Please Contact ACS at (505) 246-2056 or toll free at (800) 705-4452 for eligibility information. It is the provider's responsibility to verify eligibility.
Q: Where can I drop off abstracts and other documentation?
A: Molina has a drop box for manual submissions located outside the Molina Healthcare building. You may also drop off documentation at the front desk at Molina Healthcare, 8801 Horizon Blvd. NE, Albuquerque, NM 87113, or fax all paperwork to any of the following numbers:
(866) 553-9268
(866) 553-9272
(866) 553-9359.
Q: What is the toll free number to call for inpatient rehabilitation?
A: The Molina Healthcare TPA toll-free number is (866) 916-3250.
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Faxes
Q: Will case managers be able to fax in budgets and Level of Care forms?
A: Yes
Q: Is there a page limit on materials being faxed to Molina Healthcare TPA?
A: There are three fax machines that can accept 80 faxes at one time and there is not limit on the number of pages that are accepted.
Q: Will fax machines receive documents submitted after 5pm?
A: Yes, Molina Healthcare TPA can accept fax requests at anytime. Molina Healthcare TPA‘s electronic system will stamp all faxed information with the date and time received.
Q: Is it possible to fax complete ISD 379 packets for nursing homes instead of mailing, overnight mail or drop off?
A: Yes
Q: If a document was mailed and it had an enclosed list of items sent, would Molina Healthcare TPA stamp that list and fax it back?
A: The mail room staff can stamp and fax back the list; however this staff will not audit the listing to verify everything on the list was received.
Q: Is it better to fax requests, and what happens if the fax cuts off?
A: Yes, it is better to fax utilization review requests since Molina Healthcare TPA’s electronic system will allow anytime faxes to come in. If the fax cuts off, it is okay to submit only those pages that didn’t complete. Molina Healthcare TPA also will accept mail-in /fed-ex requests and a drop off box is available.
Q: Can providers submit documents by fax instead of handing in packets/requests in person to get a date stamped receipt?
A: Yes, except for claim forms for EMSA.
Q: Can a MAD 075 be faxed to Molina Healthcare TPA for initial consumers?
A: Yes
Q: What kind of confirmation will providers receive when the faxes submitted were received?
A: Use your fax confirmation sheet. You may also contact Molina Healthcare TPA’s Customer Services Department for confirmation.
Q: Will Molina Healthcare TPA fax questions that need to be answered regarding submissions for service from providers and case managers?
A: Yes
Q: Will service coordinators be faxed Requests For Information (RFI) at the same time the case manager is faxed?
A: RFI’s will be faxed to the individual requesting service. If the request has 2 names and numbers, both will receive the RFI request.
Q: How far in advance do you require providers to submit documentation for prior approval for continued stays?
A: 3-4 days prior to expiration of the current authorization.
Q: What is the submission cover sheet going to look like for the DD Waiver?
A: The fax coversheet is similar to the previous form, but Molina Healthcare TPA has been added to the fax coversheet.
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Prior Authorization
Q: What information should I have ready when I call Molina Healthcare TPA customer service regarding status of a prior authorization request?
A: You will need to provide:
• Recipient number, name, and date of birth
• Your provider number or NPI, and name
• The date the request was sent to us
• Item(s) or service(s) requested
Q: How will providers be notified when a request for prior approval has been completed?
A: Molina Healthcare TPA will notify you of the decision via fax/mail.
Q: Does a prior authorization guarantee payment for services?
A: No
Q: Who is responsible for providing a prior authorization (PA) number? Once it is transferred to Molina Healthcare TPA will providers receive new PA numbers for all clients or will they stay the same until their annual?
A: Continue using PA numbers that you have received. At the time new review requests are needed, you will receive a new Molina Healthcare TPA PA number.
Q: Is there an extension for PA’s entered prior to 8/1/09 by BCBS/Lovelace?
A: A request has to be submitted for extension stating this was an approval by the previous contractor.
Q: Will PA’s be updated on the New Mexico Medicaid Web Portal?
A: Yes, Molina Healthcare TPA has a process to upload authorizations into the NM Medicaid Web Portal.
Q: Molina states that you will fax back the approval information of a submitted MAD 046 form to the provider? Will the fax be sent back on the form originally submitted?
A: The approval will be sent back on the same form that the request was submitted on.
Q: Is there a dollar limit on DME supplies? Does DME equipment still require a PA?
A: DME requires a PA. Supplies are based on medical necessity.
Q: Can provider call in for follow up on PA’s?
A: Yes
Q: Is a PA required for Individual Service Plans?
A: Yes, the process has not changed.
Q: When a patient is transferred out acutely, the receiving facility has attained the approval. As a Long Term Acute Care Hospital (LTACH), do we need to be getting pre-transfer approval?
A: Yes.
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Dental
Q: How do I ensure my dental review requests are processed quickly?
A: Each day, a large number of dental requests for authorization are received. Many of these are returned to the provider for more information as the result of an incomplete ADA form or missing supporting documentation.
The most common reasons a request is returned are:
• No subscriber ID number
• No date of birth
• No Provider ID number
• Missing teeth not charted on the ADA form
• Required documentation (x-rays, charting, etc.) not submitted
• Non-diagnostic x-rays
Please take the time to look over your ADA form before submitting. Also, please look at x-rays being submitted. If they are blurry, too light or too dark, the reviewer will not be able to read them.
By making a few simple checks before you submit a request, you can ensure the process will go smoothly and you will receive your notification promptly.
Q: Are PA’s required for Dental requests for example, x-rays? Where should providers send the prior approvals?
A: All requests and supporting documentation should be sent to DentaQuest.
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Provider Services
Q: What is the phone number to speak to a provider representative?
A: (505) 348-0311 or toll-free at (866) 916-3250.
Q: Do I need to notify Molina Healthcare TPA if we're under new ownership or if we have a new NPI, Taxonomy and/or Legacy number (Medicaid Provider Number), or mailing address?
A: Yes, Molina Healthcare TPA will need the most current information to ensure that requests are processed correctly and that providers receive correspondence from Molina Healthcare TPA. Providers can call Molina Healthcare TPA toll free at (505) 348-0311 or toll-free at (866) 916-3250 to verify current information. If a change is needed, please send us the following items:
? A short letter on your letterhead requesting that we update your name and/or provider number.
A forwarding address card or a forwarding post office label showing your new address and/or name so we can update our labels to ensure that you receive our correspondence.
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Utilization Management
Q: Does the approval length of time remain the same for a Level of Care (LOC)?
A: Yes
Q: Can LOC packets and Budgets be sent together?
A: The process has not changed. If the LOC packet was previously submitted with a budget, they may be submitted together. If they were submitted separately, submit individually.
Q: Do the budgets have to be submitted within 45 days of expiration?
A: The process has not changed. Budgets are to be submitted within 45 days of expiration.
Q: Are telephone orders for LOC from nursing homes acceptable?
A: Initial packets will need to be submitted. Changes in a LOC will be accepted telephonically.
Q: For LOC’s, what is the process for re-admissions? Do the same forms need to be submitted or can the nurses still call in the authorization versus submitting any forms which is current process?
A: Continue with current process.
Q: Will providers be required to send the original ISP plan along with the budget top Molina Healthcare TPA?
A: Continue with current process.
Q: For LOC for the DD waiver will a copy of the authorization still go to the State upon approval?
A: Continue with current process.
Q: What is considered medically necessary for OT/PT rehabilitation in a Nursing Facility?
A: Medical necessity is based on the clinical information and criteria specific to the request. For additional information see HSD/MAD regulations that outline the criteria for low or high skilled nursing specific to rehabilitative services.
Q: Will Molina Healthcare TPA continue to give 2 year approvals for diapers or will the approvals only be for one year?
A: The approvals will be for one year.
Q: Will Molina Healthcare TPA submit information to providers via electronic means?
A: Yes, information will be faxed back on the same form that the request was sent.
Q: Should providers make a special note on the submissions if there is a change of services needed by a person served?
A: Yes.
Q: Have review requirements for outpatient rehabilitation changed?
A: No, continue to send the same information.
Q: Will outlier packets stay the same? Will it be the same one we currently use with BCBS?
A: Yes.
Q: What is considered medically necessary for all three types of therapy? What are the limits?
A: Medical necessity is based on clinical information regarding a recipient and established criteria. Limits are case specific.
Q: What is the process for readmission from hospital to ICF-MR?
A: The process has not changed. Please follow the previously established process.
Q: For hearing aids if the member is over 21, who covers the hearing aid Molina Healthcare TPA or Medicaid?
A: As the Medicaid TPA/UR Contractor, Molina Healthcare is responsible for conducting utilization reviews only. Molina TPA/UR is not responsible for paying claims. Please call the Medical Assistance Division for questions on Medicaid covered services.
Q: Do new PCO consumers automatically get a 75 day authorization prior to the CoLTS MCO writing the full plan? Will the auth be for 20 hours? Is this for all members or dual eligible only?
A: The PCO temporary authorization process has not changed. Any future changes will be communicated to providers by the State.
Q: Once approvals for requests are complete will they be loaded into the NM Medicaid Web Portal? Will the approvals be on the Molina Healthcare TPA website or where can we find them?
A: This process has not changed. Approvals will be available on the NM Medicaid Web Portal and the Molina Healthcare TPA ePortal site.
Q: Is 24 hours needed for sleep studies and status?
A: Yes.
Q: For re-assessment review, would a doctor’s letter be sufficient to get the process started?
A: Yes.
Q: Will Molina Healthcare TPA also call the provider if their services have a request for information or are lacking a complete packet? The case manager submits the budget but the provider often finds out weeks or months later if there is a problem because they are unable to bill.
A: Yes.
Q: For Long Term Acute Care (LTAC) facilities, are effective dates called in first then clinicals are faxed?
A: The process has not changed.
Q: What will be the process for LOC readmissions on the DD Waiver? 3 midnights? Call in by discharge planner? What are you going to send back to the case manager?
A: The process is that notification is required after 3 midnights by the facility discharge planner. The case manager will be notified as required.
Q: For LTAC patients that are in respiratory failure and on a ventilator they can receive approval by UR Nurse within 24 hours, but other patients go to the Medical Director and that process can take up to 4 days. Will this continue?
A: Molina Healthcare TPA will process these requests as quickly as possible to ensure a delay in transfer does not occur.
Q: Is Private Duty Nursing considered EPSDT? Does the case manager from the Salud program send this to you?
A: Yes, additional details are available on the Medical Assistance Division website at: http://www.hsd.state.nm.us/mad/pdf_files/provmanl/prov7463.PDF
Q: Medicaid provides for medically necessary health service to eligible recipients for outpatient rehabilitation service, physical therapy, occupational therapy and speech therapy. Is approval is required?
A: Yes.
Q: Is there any special consideration made for approvals of evaluations and treatments (ST, OT, PT) for bilingual, multicultural populations? Many clients are unable to access therapy services in their primary language. What does Molina Healthcare TPA do to ensure cultural sensitivity?
A: Molina Healthcare TPA is aware of this issue and will work with providers to ensure appropriate therapies are offered to recipients.
Q: How will abstract dates approved by Molina Healthcare TPA get to Amerigroup & Evercare? BCBS accepts telephone orders as valid LOC, will this continue?
A: Molina Healthcare TPA will fax abstracts to MCO, ISD and facility. Molina Healthcare TPA will accept telephone orders.
Q: I have current Medicaid patients with authorizations for continued care pending. Patients will still be in hospital after 8/1/09. Will Molina Healthcare TPA have the previously filed reports from BCBS?
A: Yes.
Q: Regarding the PACE Program, does Total Community Care (TCC) have their own Therapists (PT, OT, ST)? How can our agency apply to be a provider for therapy services for PACE?
A: All services must be provided by TCC. Please contact TCC for information on becoming a provider.
Q: When can members enroll and dis-enroll from the PACE program?
A: Please refer to the Medicaid PACE program policy, 8.315.2 PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) for details.
Q: Should providers use the same process for submitting requests for PACE and TCC for DME?
A: Yes.
Q: Are providers required to send PASRR abstracts to Molina Healthcare TPA or to PASRR?
A: Please continue your current process as this process has not changed.
Q: Are the completed teachings and support strategies necessary for submission with a DD Waiver recipient’s ISP? Very often the case manager’s phrasing and service coordinator who writes the T&(define) differs. This has led to the ISP being returned in the past?
A: Yes – continue with the current process. Reviews will require clear, concise language to ensure an appropriate determination.
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Personal Care Option (PCO)
Q: If you have a client on the PCO program that is going to get a transplant, what process should the provider follow?
A: The transplant process will be determined based on the client’s enrollment status in the fee for service or managed care program.
Q: Will PCO now approve for three years instead of annually? Will the MAD 075 form change?
A: Processes and forms will not change at this time.
Q: If a PCO authorization is approved for a recipient not enrolled with a CoLTS MCO, who will be responsible for entering the authorization into the Omnicaid system?
A: Molina Healthcare TPA is responsible for entering an authorization and a LOC span into Omnicaid.
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Physician Orders
Q: Are Physicians Assistants (PA) allowed to perform and sign off on H&Ps? We have heard that CMS will be allowing this sometime this year?
A: At this time, it is required that this be performed by MD/DO or CNP. If a PA is performing the service, the supervising physician must also sign.
Q: In the past, providers have been able to request reviews via telephone without the physician signature. Will verbal orders be accepted?
A: The process has not changed and yes this will be accepted.
Q: Do abstract forms need to be signed by an MD?
A: MD/DO, CNP or PA.
Q: Does the AIDS Waiver require an original signature? It is sometimes difficult to get. Will an electronic signature ever be accepted?
A: The process has not changed and original signatures are still required. The signed forms will be accepted via fax.
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History and Physicals (H&Ps)
Q: Is a H&P current for one year?
A: The H&P should be within one year from the last date.
Q: If an H & P is performed by a PA, can it be signed off by the supervising physician for the PA and submitted?
A: Yes, as long as the supervising physician has signed off.
Q: A H&P by a physician was not required before, instead 6 months of medical records were necessary for AIDS waiver, is this changing?
A: The process has not changed. If a H&P is available, Molina Healthcare TPA will accept the H&P or 6 months of recent medical records will be reviewed.
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Molina Transition
Q: When will assessments be transitioned to Molina Healthcare TPA?
A: Assessments done prior to August 1 will be transitioned over to Molina Healthcare TPA.
Q: Is Lovelace still reviewing submissions prior to 8/1/09?
A: Lovelace will start the process, but will transition to Molina Healthcare TPA as appropriate.
Q: How are current clients being transitioned?
A: Molina Healthcare TPA will receive all open cases from both BCBS and Lovelace that have not been completed.
Q: Who is ultimately responsible for eligibility for CoLTS programs?
A: The consumer is responsible to obtain financial eligibility through ISD offices. Medical eligibility is based on medical necessity determined during the assessment.
Q: For DD waiver services, if someone has a current service plan in place and the plan needs to be updated/revised, who does that go to?
A: Effective 8/1/09, the request should come to Molina Healthcare TPA for updates/revisions.
Q: What should providers do about the returned service plans and who should these be submitted to? Will Molina Healthcare TPA get access to them after 8/1/09?
A: Open reviews will be transitioned over to Molina Healthcare TPA.
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Transportations
Q: Is an ambulance company required to send in medical records with each claim?
A: The process has not changed.
Q: Why are hospital records required with ambulance run sheets and claim form? Shouldn’t this be submitted with the hospital claim?
A: Transportation providers should submit documentation indicating medical necessity. If the claim is for emergency medical services for undocumented aliens (EMSA), ACS must receive the facility claim for processing. You can contact ACS at the following link: https://nmmedicaid.acs-inc.com/nm/general/home.do
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Emergency Medical Services for Aliens (EMSA)
Q: Does Molina Healthcare TPA enroll the newborn after a baby is born to a mom covered by EMSA?
A: No, the mom must go to the local county ISD office to enroll the newborn.
Q: For EMSA, only original claim forms are acceptable? We can’t fax it?
A: No. The red-line original claim forms are required for EMSA and these claim forms cannot be faxed.
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Turn Around Times
Q: What is the turn around time for PA? And guidelines?
A: Molina Healthcare TPA will follow MAD turn-around time guidelines, and will post a grid on our website.
Q: What is the turn around time when submitting the PCO form?
A: Molina Healthcare TPA will adhere to MAD turn-around time requirements.
Q: Right now Lovelace is taking eight weeks or more from start to finish before a client can begin services. How long will Molina Healthcare TPA take?
A: Molina Healthcare TPA contractually has 45 days from start to finish. It is a goal to decrease this time as much as possible. Molina Healthcare TPA will work with the State in situations where delays may be related to State processing or computer systems.
Q: Is there still an eight day turn around time with requests?
A: Molina Healthcare TPA will be developing a grid that will show the turn-around times. This will be posted on our website.
Q: Currently the process is 14 days to respond to a denial is that changing to 10 days?
A: The process has not changed. If changes occur in time frames, all providers will be notified.
Q: When submitting for authorization to admit a patient for LOC (acute), what is the timeframe that the provider will hear back from Molina Healthcare TPA?
A: Molina Healthcare TPA will adhere to MAD turn around time requirements.
Q: If the PASSR forms go to Molina Healthcare TPA by mistake, will they be forwarded by Molina Healthcare TPA to the appropriate agency? What is the turn around time for approval?
A: Yes. Molina Healthcare TPA will stay within MAD turn-around times for approval requests.
Q: Transfer from acute to a lesser LOC, what is the turn around time to get the PA? Patients are being moved pretty quickly and we need to know how fast we will get the authorization as we cannot wait a week or two?
A: Facility transfers are processed the same or next business day to ensure facility delays do not occur. Advanced notice will be appreciated and will facilitate the process.
Q: If a Home Health referral is received on a weekend, what is the time frame for Molina Healthcare TPA to notify the provider?
A: The next business day.
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Forms
Q: Are the LTC abstracts going to remain the same?
A: The forms are currently the same.
Q: Are abstracts 378 and 379 still required for multiple programs?
A: The process has not changed, both forms will be reviewed.
Q: What is required when submitting a request for approval of Durable Medical Equipment (DME)?
A: Molina Healthcare TPA is requesting a completed MAD 303 with supporting medical necessity documentation.
Q: Is the entire medical record required to be submitted every 14 days with admission?
A: Molina Healthcare TPA is requesting that providers send in the updated information with the MAD 303.
Q: Should providers still use the MAD 075 for the D&E Waiver?
A: Continue with the process and forms that you are currently using.
Q: Therapy services are provided for individuals who came off of waiver programs or Native Americans. Do providers still follow the same process as we always have? Are the forms the same?
A: Yes, continue using the same forms.
Q: If an authorization for disposables was given to another provider and the member wants to change providers, is Molina Healthcare TPA requiring a letter from the members along with the MAD 303 form to get the services transferred?
A: Yes.
Q: Will the MAD forms be provided online or will the providers have to print them and then fill them out and send them to Molina Healthcare TPA?
A: Molina Healthcare TPA will have a link to all required forms, but at this time, they cannot be completed electronically.
Q: When more than one MAD 046 is faxed in for the same individual, will each MAD 046 be approved and then faxed back to the sender?
A: If the MAD 046 is not a duplicate, yes, each will be faxed back.
Q: When do providers begin sending UR forms to Molina Healthcare TPA?
A: The effective date for EMSA is 7/1/09. All other UR requests are effective 8/1/09.
Q: For DME home care, will providers still submit on the same form?
A: Yes.
Q: Should providers continue to submit the cover sheet that the Aging and Long-Term Services Department created with packets currently being submitted?
A: Yes, please continue the current process.
Q: Will Molina Healthcare TPA send approved level of care forms to ISD at the same time they are sent to the case manager?
A: Molina Healthcare TPA will send the required forms to ISD as instructed.
Q: For the forms Molina Healthcare TPA creates, would you consider not using shading or black bolds?
A: Molina Healthcare TPA will take this into consideration when changing or updating forms.
Q: Are UR forms going to vary plan to plan or will they become uniform?
A: Molina Healthcare TPA will be working with the State to develop a universal form.
Q: Long term acute care hospital (LTCAH) currently uses MAD 331 for rehabilitation, though not always the most appropriate form. Will Molina Healthcare TPA have a new form that better addresses the LTACH needs?
A: At this time, continue using the same form.
Q: What form will now be used for outpatient physical, occupation, and speech therapy? (not from a nursing facility)
A: The process and forms have not changed.
Q: What is an ISD 379 form?
A: This form is a Long Term Care Assessment Abstract.
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Requests for Information (RFIs)
Q: How can I avoid Requests for Information (RFIs)?
A: Providers should ensure that you are using the most current MAD form and fill out the form completely.
• Ensure that the client's Medicaid number is entered correctly as well as all procedure/provider codes.
• The forms and documentation must contain all required signatures (H&P, Medical Assessments, and Level of Care Orders with corresponding dates).
• It is important to be familiar with the criteria for the services you are requesting so you can submit all mandatory and supporting documentation (ensure that the information submitted is consistent and relevant to that specific request).
• Before submitting the form, review the entire document and double-check mathematical calculations.
• Clarify your request (e.g., is the request a "Re-review," "Reconsideration," "Re-admit," "Closure," or "Transfer").
Q: How many times will you send back RFI’s before issuing a denial? At what point is a denial issued?
A: Molina Healthcare TPA will request additional information, as necessary for review, by first contacting the provider via phone. If the request is not received within 3 days, another call will be made. If the information is not received after another 3 days, a fax will be sent with the date that the denial will be issued if the request is not received.
Q: Will providers have the direct phone numbers to contact the appropriate person/agent at Molina Healthcare TPA for RFI’s?
A: Yes.
Q: Will it be possible for Molina Healthcare TPA not only to call the person that submitted the budget but the person that is being affected by the lack of budget or the PCO agency as well when there are requests for RFI’s?
A: Molina Healthcare TPA is aware of this issue and is working with agencies and case mangers to resolve the communication issues. Further discussion will take place to ensure that a smooth process is in place for notifications.
Q: If the residential/day provider, not the case manager agency, submits the six month outlier packet, will Molina Healthcare TPA fax the approval to the residential provider? Will Molina Healthcare TPA call the residential provider if the packet is missing information rather than the case manager? Currently these packets are submitted by the residential provider and any communication is with the provider, not the case manager?
A: Molina Healthcare TPA is aware of this issue and is working with agencies and case mangers to resolve the communication issues. Further discussion will take place to ensure a smooth process is in place for notifications.
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Billing
Q: For billing, is Payer Path remaining as the clearing house for DD Waiver clients?
A: Please contact ACS for questions related to fee for service claims billing.
Q: Does Mi Via billing go to the same place?
A: Yes, billing does not change.
Q: What does ACS stand for and is ACS remaining as the fiscal agent?
A: Affiliated Computer Services, and yes ACS will continue as the Medicaid fiscal agent.
Q: Will Molina Healthcare TPA now do billing?
A: No.
Q: Is Molina Healthcare TPA taking over for initials with ACS? Who gets billed for new clients?
A: ACS is the current Medicaid fiscal agent.
Q: Will the remittance advices still be printed off of the ACS Web Portal?
A: Services related to claims, billing and remittance advices have not changed.
Q: Will the online billing process for waiver providers remain the same?
A: Billing will not change.
Q: Is Molina Healthcare TPA paying for emergency services related to psychological outbursts or behavioral problems?
A: Please contact the Medical Assistance Division for questions related to covered services and benefits.
Q: What are time frames for billing from the beginning to the end of an episode?
A: Molina Healthcare TPA does not pay claims.
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General Questions
Q: Will Molina Healthcare TPA be sending out new insurance cards to all the members?
A: No. Molina Healthcare has been contracted by the State to conduct utilization review and third-party assessments for certain home health, long-term care, Home and Community-Based services and fee-for-service which were previously contracted to Blue Cross Blue Shield of New Mexico Utilization Review and Lovelace Health Plan Third-Party Assessor.
Q: Will there be translators for members who speak Navajo out in the rural areas?
A: Yes, our translation line may be utilized for this.
Q: Is Molina Healthcare TPA hiring more staff to help with this product?
A: Yes.
Q: Is Molina Healthcare TPA contracting with nurses to complete the assessments?
A: Molina Healthcare TPA is in the process of contracting with several qualified providers in the community to complete the assessments.
Q: Will Molina Healthcare TPA be working with same assessment reviewers out in the community?
A: Molina Healthcare TPA is in the process of contracting with several providers in the community.
Q: Has Molina Healthcare TPA been mandated to cut costs by anyone or the state to save money? Will Molina Healthcare TPA cut or decrease services to people on the DD Waiver?
A: Medicaid policy decisions are determined by the State. Please contact the Human Services Department for information.
Q: I am a behavioral health provider and see clients/patients who are covered by Medicaid Salud! I saw/heard nothing about behavioral health (BH) services, are these not included by Molina?
A: The Molina Healthcare TPA/Utilization Review contract does not cover the Medicaid Salud! program. Please contact the Molina Salud! program for questions related to Molina Salud! services.
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