Thank you for your interest in becoming a Molina Healthcare of Michigan Provider. To ensure the proper contract and credentialing packet is generated; please complete this contract request form. (Michigan providers only)
If you are adding providers to a participating group or PHO/PO, please submit a Provider Addition Roster to MHMContractConfigDept@Molinahealthcare.com. For questions, please call the Provider Call Center at (855) 322-4077. Requests for provider additions on this template will not be processed.
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