Molina Healthcare TPA Contact Info
Customer Service Telephone Numbers for Providers and Recipients:
Check status of review requests Monday through Friday (except holidays) 8:00 am – 5:00 pm
(505) 348-0311 (Albuquerque local)
(866) 916-3250 (outside of Albuquerque toll-free)
Utilization Management:
Telephone requests Monday through Friday (except holidays) 8:00 am – 5:00 pm
(505) 348-0311 (Albuquerque local)
(866) 916-3250 (outside of Albuquerque toll-free)
Fax requests (all toll-free) available 24 hours a day, seven days a week:
(866) 553-9268
(866) 553-9272
(866) 553-9359
*An automated sort distribution system is used to ensure that faxes are routed to the correct department and reviewer.
Mail requests:
Molina Healthcare of New Mexico – Third Party Assessor
PO Box 3909
Albuquerque, NM 87190
Provider Reconsideration Process
Providers who disagree with review decisions can request a reconsideration within 30 calendar days from the date of the decision letter.. The request must be in writing and may include the following information to support the reconsideration (See State Regulations 8.350.2 NMAC):
1) Reference to the challenged decision or action;
2) Basis for the challenge;
3) Copies of any document(s) pertinent to the challenged decision or action which were not submitted with the original request;
4) Copies of claim form(s) if the challenge involves a claim for payment which is denied due to utilization review decision.