SALUD is a medical program that provides services at no cost or low-cost for people on Medicaid.
*The files below are in PDF format () and are also found in the Provider Manual.
Prior Authorization Requirements
The forms below are for providers interested in becoming Molina Healthcare practitioners/providers.
PLEASE NOTE: The Disclosure Form must accompany the Provider Information and Facility Information Forms. Please fax completed forms to (505) 798-7313, or email directly to your designated Provider Service Representative. Provider Services Territory Map
Third Party Assessor (TPA) forms can be found under the corresponding links in the TPA area.
*The files below are in Word format ()
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