Select your State and Language
Find out if you can become a member of the Molina family. Pick your state and your preferred language to continue.
Cookies
We use cookies on our website. By using our website, you consent to our use of cookies in accordance with our Privacy Policy. Read more
Find helpful resources, plan materials, payment information and more. Enter a query above to search our website.
Categories
Email this page
Thank You!
Your message has been sent.
Unable to send email, contact IT Support Team
Select your plan to look up covered drugs
Please note that these links will take you to an external website.
Select your plan year to find a pharmacy
Thank you!
Tell Us what You Think..
We appreciate your feedback about our website.
Rate This Page
Overall Satisfaction with this Website
Ease of Use
Information
Almost There… Let us help you enroll today!
We've received your information and a representative will be in touch with you shortly.
{80692560-8A36-43CB-8836-C57F3A6E0584}
Unable to process request temporarily
*This is a solicitation for insurance and an agent may contact you.
By providing your email address, you are opting to receive health plan information and marketing email communications. You can unsubscribe at any time.
The Availity Essentials portal provides access to all portal functions.
Getting Started
Make a Payment
Forms and Documents
When can you Enroll?
FAQ
2025 Marketplace Provider Manual
Wisconsin Marketplace Pharmacy Prior Authorization Form
Q1 2025 PA Code Matrix
Q1 2025 WI Marketplace Prior Auth (PA) Code Matrix
Q1 2025 WI Marketplace PA/Pre-Service Review Guide
No Surprises Act - Independent Dispute Resolution Form (Non-Contracted Providers only)
Prior Authorization LookUp Tool
Grievance Consent Form
Provider Appeal Form
Behavioral Health Prior Authorization Form
Combined MCE Behavioral Health Provider Primary Care Provider Communication Form
Molina Healthcare of WI- Practitioner Application
Molina Healthcare Health Delivery Organization (HDO) application - 2020
Molina Healthcare of WI CAQH Credentialing Checklist
Web Portal Admin Change Form
Case Management Referral Form
Clinical Care Coordination Referral Form
Pregnancy Notification Form
Provider Information Update Form
Quick Reference Guide