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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...
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...
Does Molina offer Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT)?
Yes. Molina Healthcare offers ERA/EFT through Change Healthcare, who has contracted with ECHO Health for thes...
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...
Beginning July 1, 2024, a Single Pharmacy Benefit Administrator (SPBA) will begin providing pharmacy services for all health plans for Medicaid and CHIP beneficiaries. Gainwell will be responsible f...
The guidelines below were reviewed and adopted by the Molina Healthcare National Quality Improvement Committee. Committee approval dates are shown for 2015 and beyond. All guidelines are reviewed mon...
All clinical practice guidelines are based on scientific evidence, review of the medical literature, or appropriately established authority, as cited. All recommendations are based on published consen...
Preventive Care Guidelines can be beneficial to the provider and his/her patients. All practice guidelines are based on scientific evidence, review of the medical literature, or appropriately establis...
