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
Interested Providers
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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