For questions about any of the following areas, please select the appropriate link:Submitting Electronic: Claims, Referral Certification and Authorization1-866-409-2935Email Directly: EDI.Claims@Molin...
aMolina Healthcare’s HIPAA 5010 Readiness *Molina Healthcare is ready to test the 5010 versions of the HIPAA transactions with providers and other trading partners. We look forward to working collabo...
The Federal HIPAA regulations issued by DHHS dictate that only approved code sets may be used in standard electronic transactions. The CMS site has official resources that define these standard code s...
Molina Healthcare has implemented the HIPAA NPI requirements. Beginning May 23, 2008, HIPAA standard transactions must include NPIs. No legacy identifiers (other than the billing/pay-to provider's Ta...
HIPAA Standards for Electronic Healthcare TransactionsHIPAA required the Department of Health and Human Services (HHS) to adopt national standards for electronic healthcare transactions. All covered e...
Since HIPAA’s inception, Molina Healthcare has worked diligently and collaboratively with the broader healthcare community to achieve compliance with the federal HIPAA transactions requirements. Molin...
Molina Healthcare of California ("Molina") seeks to uphold the highest ethical standards for the provision of health care benefits and services to its members, and supports the efforts of feder...
PROVIDER Claim Disputes- THE “APPEALS PROCESS”
A Provider/Practitioner grievance or complaint is described in Title 22, California Code of Regulations (CCR), as a written entry into the appeals proc...
The Molina Healthcare Quality Improvement (QI) Program provides the structure and key processes that enable the health plan to carry out its commitment to ongoing improvement of care and service, and ...
Long term services and supports are Medi-Cal benefits that help members with ongoing personal care needs. Molina will work with the member's doctors and long term services and supports providers to ar...
