Welcome Molina Medicare Providers!

It is important to Molina Healthcare and your patients that your provider directory demographics are accurate. Please visit our Provider Online Directory at: https://molina.sapphirethreesixtyfive.com/ to validate your information and notify us if there are any updates.

Please notify Molina Healthcare at least 30 days in advance when you have any of the following:

  • Change in office location, office hours, phone, fax, or email
  • Addition or closure of office location
  • Addition or termination of a provider
  • Change in Tax ID and/or NPI
  • Open or close your practice to new patients (PCPs only)

Changes for 2024:

  • Existing Molina States: Arizona, California, Idaho, Illinois, Michigan, Nevada, Ohio, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin
  • Service Area Expansions:     
    • 8 New Counties in Michigan
    • 39 New Counties in Illinois
    • Partial to Full County Expansions in California (Los Angeles, Riverside, San Bernardino, San Diego, and Imperial)
  • New Plan/Plan Segmentations/Member Crosswalks:
    • California H5810-001 plan members will crosswalk to H3038-001
    • California H5810-013 plan members will crosswalk to H3038-002
    • California H5810-016 plan members will crosswalk to H3038-003
    • Washington H5823-011 plan members will crosswalk to H5823-012-001 or H5823-012-002, based on county
  • Plan Sunsets:
    •  We will not be offering Medicare Advantage plans in Florida and New Mexico in 2024
    • Arizona - Molina Medicare Choice Care Select (HMO)
    • Nevada - Molina Medicare Choice Care Select (HMO)
    • Texas - Molina Medicare Comfort Care (HMO I-SNP)

Provider Manuals

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Forms

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EDI/ERA/EFT

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Prior Authorization Forms

Medical, BH, Pharmacy

2024 Medicare PA Guide
2024 Medicare PA Form
2024 Medicare BH PA Form
2024 Medicare Pharmacy PA Form
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PA Criteria

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Guidelines

Clinical Practice Guidelines
Provider Portal User Guide
MCG Cite AutoAuth Provider Access Quick Resource Guide

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Model of Care

2024 Model of Care Provider Training Quick Reference Guide
2024 Model of Care Provider Training 

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Health Resources

Behavioral Health Toolkit
Culturally and Linguistically Appropriate Resources
Medical Record Standards
Quality Improvement
Home Care FAQ

HEDIS/CAHPS

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Formulary

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Policies

Member Rights & Responsibilities
Provider Rights & Responsibilities
Advance Directives
Credentialing Rights
Fraud Prevention
Patient Safety
In Office Laboratory Tests

Payment Integrity Policies

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Communications

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Rx Forms

How to Request a Redetermination

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Redetermination Form

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Direct Member Reimbursement Form

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Medicare Compliance Program

The Molina Compliance Hotline:
Ph: 866-606-3889

To report an issue online visit: https://molinahealthcare.AlertLine.com

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Medicare Compliance Training

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