Please familiarize yourself with the Drug Formulary as you prescribe medications for Molina Healthcare members. Thank you for your cooperation.
Preferred Drug List (PDL) & Rx Prior Authorization Form...
Types of EDI Transactions
Electronic Data Interchange (EDI) functionality is utilized by Molina Healthcare of Arizona to complete several types of ASC X12N Version 5010 transactions, including:
C...
Page Content
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Claims
Provider Dispute Resolution Request Form
Credentialing
CAQH Provider Data Portal
HIV and AIDS Specialist Form
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Current 2025 Notices
HHSC to Begin Collecting FMSA SFY 2024 Cost Survey
Rider 32 Electronic Visit Verification (EVV) Provider Impacts
Change in Preferred Drug List Status for Glucocorticoids, Inhaled...
Types of EDI Transactions
Electronic Data Interchange (EDI) functionality is utilized by Passport to complete several types of ASC X12N Version 5010 transactions, including:
Claims Submission (83...
Our mission is to maximize the quality of life, health, security, and independence for our members who are covered by Molina Healthcare. It is critical that we provide members with top quality care an...
Thank you for your interest in joining our Senior Whole Health network.
Please complete the Provider Contract Request Form below:
Provider Contract Request Form
Incomplete submissions will be rejected...
