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Provider Manual

Welcome to Molina Healthcare of Washington, Inc. Enclosed please find your Molina Provider Manual, written specifically to address the contractual and regulatory requirements of delivering health care services to Washington State's Apple Health Family/Pregnancy Medical (AHFAM), Apple Health Blind/Disabled (AHBD), Apple Health with Premium (AHPREM) and Apple Health Adult (AHA) members.

Effective April 1, 2016 Clark and Skamania Counties, also known as SW WA region, is the first region in the State to implement Fully Integrated Managed Care (FIMC) and Behavioral Health Services only (BHSO). This manual has been updated to include the contractual and regulatory requirements of delivering healthcare services for these new lines of business Apple Health FIMC with Premium (FIMC-PREM), Apple Health FIMC Family/Pregnancy Medical (FIMC-AH), Apple Health FIMC Adult (FIMC-AHA), Apple Health Blind Disabled FIMC (FIMC-BD) and Behavioral Health Services Only (BHSO) members.

The manual is designed to provide you with assistance in all areas of your practice, from making referrals to receiving payment for your services. In some cases you may have developed internal procedures that meet the standards set out in this manual. In these instances you do not need to change your procedures - as long as they adhere to the standards outlined in the manual.

The manual contains samples of the forms needed to fulfill your obligations under your Molina Healthcare contract. If you are already using forms that accomplish the same goals, you may not need to modify them. The sample forms are included to illustrate what is needed for appropriate documentation.

From time to time we will need to update and revise this manual as our policies or regulatory requirements change. All changes will be sent to you as additions or deletions to this manual. You simply need to replace old pages with the new ones.

We thank you for your active participation in the delivery of quality health care services to our members and look forward to working with you.

Although this manual contains a comprehensive summary of Molina Healthcare of Washington’s policies and procedures, additional protocols regarding plan administrative practices, full plan medical policies, and other detailed information are available to the provider upon request by calling the Molina Customer Service Department.

Please keep this manual handy for reference, and contact us at (800) 869-7165 should you have any questions.

 

​Molina Provider Manual

The files below are in PDF format ( icon PDF )

2017

 

 

 

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