Provider Resource Guide

Welcome to Molina Healthcare of Ohio; we are glad you made the decision to become a part of our network!

The Member Services Department handles all telephone and written inquiries regarding claims, benefits, eligibility/identification, selecting or changing Primary Care Providers, and Member complaints. Member Service Representatives are available 7:00 a.m. to 7:00 p.m. Monday through Friday.

To verify eligibility, call the Member Services Department at the above number. You may also verify eligibility through the Molina Healthcare Website: http://www.molinahealthcare.com

The Claims Department is located at our corporate office in Long Beach, CA. All hard copy (HCFA 1500, UB92) claims must be submitted by mail to the address listed below. Electronically filed claims must use EDI payer ID number -20149

More information about Molina Healthcare and the claims and billing processes can be found on the Molina Healthcare website: http://www.molinahealthcare.com

To verify the status of your claims, please call our Provider Claims representatives at the numbers listed above.

The Healthcare Services Department conducts concurrent review on inpatient cases, provides case management, and processes prior authorization requests.

Referrals to network providers do not require authorization from Molina. However, requests for some services must be approved by Molina Healthcare in advance. Please see the prior authorization form for the list of procedures that require prior authorization and the instructions for submission.

You may also submit authorization requests through the Molina Healthcare Website: http://www.molinahealthcare.com

Molina Healthcare Preferred Drug List requires certain medications to be prior authorized. If you have questions regarding the Molina Healthcare Preferred Drug List and/or drug prior authorization requests you can call Molina Healthcare.

Participating pharmacies are listed in the provider directory and on our website: http://www.MolinaHealthcare.com

The Provider Services Department handles telephone and written inquiries from providers regarding address and Tax-ID changes, Provider Claim Reconsideration, contracting, and training.

Federally Qualified Health Center/Rural Health Clinic Billing Information

Listed below are the MMIS Provider Billing Numbers to be utilized in billing ODJFS for the wrap-around payment.

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