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Molina Healthcare is advising our providers of a critical outage of our third-party vendor Optum-Change Healthcare (CHC), resulting in impacts to: Electronic Claims Submission, Payment, and Settlement Services.
The Availity Essentials portal provides access to all portal functions.
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Forms and Documents
When can you Enroll?
2024 Marketplace Provider Manual
Prior Authorization LookUp Tool
Authorization Reconsideration Form
Molina Healthcare Prior Authorization Request Form and Instructions
Medicaid: Q2 2024 PA Code Changes
Medicare and MMP: Q2 2024 PA Code Changes
Marketplace: Q2 2024 PA Code Changes
Medicaid: Q1 2024 PA Code Changes
Medicare and MMP: Q1 2024 PA Code Changes
Marketplace: Q1 2024 PA Code Changes
PA Code Lists and Changes Archive
Ohio Urine Drug Screen Prior Authorization (PA) Request Form
Observation Level of Care FAQ
Pain Management Procedures
Corrected Claim Billing Guide
Request for Claim Reconsideration
In-Office Laboratory Test List
In-Office Laboratory Test Archive
Well Care-OB/GYN Service Coding Guide
Return of Overpayment
No Surprises Act - Independent Dispute Resolution Form (Non-Contracted Providers only)
Synagis (RSV) Authorization
Home Health Prior Authorization Quick Tips
Pharmacy Universal Claim Form
Prior Authorization Request Form
Marketplace Authorization and Claim Reconsideration Guide
PAC Provider Intake Form
Endometrial Ablation Procedures
Ohio Provider Contract Request Form *
*For first-time providers wanting to contract with Molina Healthcare of Ohio (MHO), or for existing MHO providers wanting to add a new product to their contract.
Provider Information Update Form
CAQH Provider Data Form
Ownership and Control Disclosure Form
Availity Essentials Overview
Availity Payer Spaces Single Sign On Features