Filing an Appeal or Grievance with Molina Healthcare of Arizona (Molina)

There are several ways members or their authorized representative (including a provider on behalf of a member) can file a grievance with Molina:

By phone: (800) 424-5891

Monday-Friday 8 a.m. to 6 p.m. MST.

By email: MCCAZ-PrvDisputes@molinahealthcare.com

By fax: (888) 656-7504

By mail: Members or their authorized representative may submit a grievance by mail to:

Molina Healthcare of Arizona

Attn: Appeals and Grievance Department

5055 E Washington St, Suite 210

Phoenix, AZ 85034

Members or their authorized representative also have the right to file an external grievance against Molina. Grievances against Molina may be filed through the AHCCCS Medical Management Helpline at (602) 417-4000 or (800) 654-8713 outside of Maricopa County

Filing an Appeal with Molina

An appeal can be filed within 60 days of the date on the Notice of Adverse Benefit Determination. Once the notice is received, there are several ways an appeal can be filed:

By phone: (800) 424-5891 Monday-Friday 8 a.m. to 6 p.m. MST.

By email: MCCAZ-AppealGrieve@MolinaHealthCare.Com

By fax: (888) 656-7504

By mail: Members or their authorized representative may submit a grievance by mail to:

Molina Healthcare of Arizona

Attn: Appeals and Grievance Department

5055 E Washington St, Suite 210

Phoenix, AZ 85034

If a member or their authorized representative chooses to submit a standard appeal orally, they must also submit the request in writing within 10 days of the date of the oral request. Expedited appeals filed orally do not require a written follow-up.

Standard Appeal Process

Molina will review all documentation received regarding the appeal and will render a determination within 30 days of the appeal request.

Members may request an extension of up to 14 days. Molina may also request an extension of up to 14 days if we require additional information to render a decision. In the event Molina requests an extension, members or their authorized representative are notified both orally and in writing. We will call you and send a written notice within two calendar days explaining the reasoning behind extending the timeframe. You have the right to file a grievance if you disagree with the extension.

If the member or their authorized representative does not agree with Molina’s decision regarding the appeal, they may request a State Fair Hearing.

Expedited Appeal Process

Molina will review all documentation received regarding the appeal and will render a determination within 30 days of the appeal request.

Members may request an extension of up to 14 days. Molina may also request an extension of up to 14 days if we require additional information to render a decision. In the event Molina requests an extension, members or their authorized representative are notified both orally and in writing. We will call you and send a written notice within two calendar days explaining the reasoning behind extending the timeframe. You have the right to file a grievance if you disagree with the extension.

If the member or their authorized representative does not agree with Molina’s decision regarding the appeal, they may request a State Fair Hearing.

State Fair Hearing Request

If the member or their authorized representative do not agree with Molina’s decision regarding their appeal, they may request a State Fair Hearing in writing within 120 days from the date on the Notice of Appeal Resolution sent to them.

Information about how to request a State Fair Hearing is included in the Notice of Appeal Resolution.

To request a State Fair Hearing in writing, please send a letter to:

Molina Healthcare of Arizona

Attn: Appeals and Grievance Department

5055 E Washington St, Suite 210

Phoenix, AZ 85034

Continuation of Care

A member or authorized representative may request a continuation of care within 10 calendar days of the Adverse Benefit Determination Notice or intended date of the Adverse Benefit Determination Notice. Requests for continuation are considered if the appeal involves the following:

  • Termination, suspension or reduction of a previously authorized service
  • A denial of service(s) which the provider asserts that the service(s) or treatment(s) is/are a necessary continuation or a previously authorized service
  • The services were requested by an authorized provider and at the time the appeal was filed, the original authorization had not expired

Please note that Molina may recover the cost of continued services if the final resolution of the appeal or State Fair Hearing upholds our denial.

Provider Claims Disputes

Providers may challenge a claim payment, denial or recoupment through the claim dispute process. Claim disputes must be filed in writing no later than 12 months from the date of eligibility posting, or within 60 days after the payment, denial or recoupment of a timely claim submission, whichever is later. Claim disputes must provide the factual and legal basis for the dispute and the relief requested.

Claim disputes may be emailed  MCCAZ-AppealGrieve@MolinaHealthCare.Com or sent by mail to:

Molina Healthcare of Arizona

Attn: Provider Claim Disputes

5055 E Washington St, Suite 210

Phoenix, AZ 85034

Unless agreed to by Molina and the provider, we will provide a written determination within 30 calendar days of the dispute receipt date.

It is important to note that correspondence received specifically indicating a request for the reconsideration or resubmission of a claim will be forwarded directly to Molina’s claims department for review and determination.

If the provider does not agree with Molina’s claim dispute determination, they may request a State Fair Hearing.

State Fair Hearing Request

If a provider does not agree with Molina’s decision regarding their appeal, they may request a State Fair Hearing in writing within 30 calendar days from the date on the Notice of Decision sent to them. Information about how to request a State Fair Hearing is included in the Notice of Determination.