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Welcome, Florida Healthcare Providers

Contracted providers are an essential part of delivering quality care to our members. We value our partnership and appreciate the family-like relationship that you pass on to our members.

As our partner, assisting you is one of our highest priorities. We welcome your feedback and look forward to supporting all your efforts to provide quality care.

If you have any questions, please call Provider Services at 1-855-322-4076.

Claims Denied for Missing Documentation

Claims denied for missing or additional documentation requirements such as consent forms, invoices, Explanation of Benefits from primary carrier, or itemized bills are not considered claim disputes. In order to process your claim appropriately and promptly, these documents, along with a copy of the claim, must be received within federal and state timely filing requirements and/or your Provider Services Agreement. Please mail the documentation with the copy of the claim to:

Molina Healthcare of FL
P.O. BOX 22812
Long Beach, CA 90801

Please Note: As of January 15, 2020, disputes received for denial reasons stated above will be rejected.

Stop Loss Claims Review Eff: 01/15/20

Molina conducts medical claim reviews on inpatient claims, as noted in the provider agreement, to ensure claims are reimbursed in accordance with generally accepted Federal, State, and AMA billing and coding guidelines.

The process includes review of claims from a pre-payment perspective to ensure claims are billed and paid appropriately. This process includes review of:

  • Room and Board charges
  • Items/services not included in the Room and Board category that are considered nonroutine and patient specific
  • Any billing errors identified.

Based on this review, Molina identifies disallowed charges and services to determine correct payment in accordance with Federal or State reimbursement methodology and/or provider specific contract terms.

Please ensure that any claim associated with stop loss, or payment in excess of the DRG amount, is accompanied with an itemized statement in order to ensure timely processing of your claim. There should be no impact on claims processing timeliness, in accordance with 641.3155, F.S. This process will be in effect as of January 15, 2020.

If Molina identifies disallowable charges in your claim, you can dispute our decision by following the routine claim appeal/dispute process that is outlined in the provider manual and/or provider contract. ​​

New Vendor Update

​Please be advised that effective July 1, 2019, Molina Healthcare of Florida is starting a new partnership with Health Network One, Inc. (HN1)/American Therapy Administrators of Florida (ATA-FL) and Coastal Care Services.


For DME, Home Health and Home Infusion services, Molina Healthcare’s new exclusive partner will be: Coastal Care Services.

Authorization Requests:

  • MMA, Marketplace, and Medicare:

    • Coastal - All services under will require authorization and you will be required to follow Coastal’s Prior Authorization process.

  • Long-Term Care/Comprehensive (MMA & LTC):

    • Molina - You will continue to follow Molina’s Prior Authorization process.

      ​​Coastal Care Services
      Toll-Free: 1-855-481-0505
      Web: www.ccsicare.com
      Monday – Friday 8:30AM – 5:00PM

      For more information on services not covered by Coastal Care Services, please click here.


      For Free-Standing Therapy services (Physical, Occupational, and Speech), Molina Healthcare’s new exclusive partner will be: Health Network One (HN1)/American Therapy Administrators of Florida (ATA-FL).

      *Please Note: This therapy transition is only delegated for therapies in Free-Standing facilities. Molina is still responsible for therapies in a hospital outpatient or inpatient setting.

      Authorization Requests:

      • MMA, Marketplace, and Medicare:

        • HN1/ATA-FL - All services will require authorization and you will be required to follow HN1/ATA-FL’s Prior Authorization process.

      • Long-Term Care/Comprehensive (MMA & LTC):

        • Molina - You will continue to follow Molina’s Prior Authorization process.

      Health Network One/American Therapy Administrators
      Toll-Free: 1-888-550-8800
      Web: www.ataflorida.com
      Monday - Friday 830AM – 5:00PM

    For more information on Molina Healthcare’s vendor transition, please contact Molina’s Provider Services Department at 1-855-322-4076 for any questions or concerns.

    Thank you for your assistance and cooperation.

      TRANSPORTATION UPDATE

      Effective April 1, 2019 Molina Healthcare will provide Non-Emergency Transportation through Access2Care Transportation to assist its Members with keeping, and traveling to medical appointments.

      To make a reservation for a transportation service after 04/01/19, contact Access2Care’s reservation line for Molina Healthcare MMA/LTC Members at: (888) 298-4781.

      If Member needs further assistance, they can also call (866) 472-4585 and a Member Services Representative will assist them with this request. ​

      ATTENTION PROVIDERS!!!

      Providers should use QUEST DIAGNOSTICS, our preferred provider for laboratory services when referring members for lab services not covered in the office.

      Claims for tests performed at non-par labs without prior authorization will be denied. Medically necessary laboratory services ordered by a PCP or other care provider performed at Quest typically DO NOT require prior authorization (except as noted on our prior authorization list.)

      In-Office Labs
      Molina allows only certain laboratory tests in the physician’s office. All other medically necessary laboratory testing must be directed to an in-network Laboratory such as Quest Diagnostics by the ordering physician (i.e.: specimens dropped in the Quest box for pick-up). For a list of approved in-office laboratory tests, including tests such as Rapid Strep, visit the “Forms” link above, and click on “In-Office Tests List”.

      Claims for lab tests performed in the physician office, but NOT on Molina’s list of allowed in-office or otherwise authorized, may be denied payment.

      For the latest list of patient services centers (draw sites), please reach out to Quest Diagnostics or view Molina’s Online Provider Directory.

      Quest Diagnostics
      866-MYQUEST (866-697-8378)
      www.questdiagnostics.com

      ​​​​

      Provider Services Portal

      Check Member Eligibility & Benefits button

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      Molina’s Provider Self Services has a variety of tools to simplify your transactions whether you need to check eligibility or check claim status. For more information contact Provider Services. Molina Healthcare is now collecting National Provider IDs (NPIs) from contracted and non-contracted providers. Submit your NPI to Molina via our Provider Self-Services Portal.

      For more information on Electronic Visit Verification please click here​​

      Reminder: Molina is GOING GREEN as of July 1st and all claims need to be submitted through an EDI Clearinghouse or via Molina's Provider Portal. Please contact our Provider Services team if you have any questions.

      Providers

      Molina's MMA Physician Incentive Program

      Click here
       
       
      ​​​​
      Doctor

      Free Online CME Credits!!

      Primary Care Providers - To Earn Extra CME Credits - Click Here

      Important Reminder:

      It is important to Molina Healthcare and your patients that your provider directory demographics are accurate. Please visit our Provider Online Directory at: providersearch.molinahealthcare.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)

      LTSS Quick Reference Guide

      Looking for information about requesting authorization or submitting a claim for Long-Term Services and Supports? Learn more.​

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