Clinical practice guidelines are documents which seeks to guide decisions about the diagnosis and treatment of certain health conditions. Clinical practice guidelines are based on scientific evidence,...
Molina Healthcare's Health Education programs will be incorporated into the Member's treatment plan to address the Member's health care needs. Primary prevention programs may include smoking cessatio...
The Healthcare Services (formerly Utilization Management) Department conducts inpatient review on inpatient cases and processes Prior Authorizations/Service Requests. The Healthcare Services (HCS) Dep...
Molina maintains access to care standards and processes for ongoing monitoring of access to health care (including behavioral health care) provided by contracted primary PCPs (adult and pediatric) and...
Molina Healthcare of Mississippi seeks to uphold the highest ethical standards for the provision of health care benefits and services to its members, and supports the efforts of federal and state auth...
The Patient Safety Program identifies appropriate safety projects and error avoidance for Molina Healthcare members in collaboration with their primary care providers.Molina continues to support safe ...
Clinical practice guidelines are designed to guide decisions about diagnosing and treating specific health conditions. These guidelines are based on scientific evidence, medical literature reviews, or...
Claim Management for Missing or Incorrect Member Information Effective December 7, 201801/03/19Molina Healthcare would like to notify our provider partners of a change to the management of claims subm...
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...
You may have to pay for services that are not covered. You may also have to pay for services from providers not part of our network. If the services were an emergency, you don’t have to pay. If you ne...
