Molina Healthcare wants to ensure that members who may have been displaced and affected by the recent wildfires have access to their needed medications, DME or medical supplies. Here are the process...
Types of EDI Transactions
Electronic Data Interchange (EDI) functionality is utilized by Molina to complete several types of ASC X12N Version 5010 transactions, including:
Claims Submission (83...
Note: The Health Care Authority (HCA) implemented the Apple Health Preferred Drug List (PDL) on January 1, 2018. All managed care plans and the fee-for-service program serving Apple Health clients wil...
Molina has established Molina Clinical Review (MCR) that function as one of the sets of guidelines for coverage decisions or determinations. Please know that these clinical reviews do not constitute p...
The Medicaid Prior Authorization Guide is a listing of codes that allows contracted providers to determine if a prior authorization is required for a health care service and the supporting documentati...
Complex Behavioral Health Services (CBHS)
CBHS is a new program that began July 1, 2024, offered under the 1915i state plan. This program helps people who have a significant mental health diagnosis a...
For Molina Healthcare adult members of Apple Health (Medicaid). The Bariatric Surgery Program is available to Washington State residents only.
Program Eligibility Criteria
Program eligibility is based...
Molina’s UM Department is designed to provide comprehensive health care management by managing utilization services and benefits effectively and efficiently.
UM Decision Making
Molina follows a hierar...
