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For MMA Providers:

Pursuant to Specific Appropriation 211 of the 22/23 General Appropriations Act (GAA), the Agency for Health Care Administration (AHCA) received state finding for the sole purpose of raising wages of direct care employees of Medicaid providers including 1099 direct care employees who provide services under the Florida Medicaid Program. As required, providers should have entered into a supplemental wage agreement with AHCA, which requires each provider to agree to pay each of its employees, who provide services under the Florida Medicaid Program, at least $15.00 per hour.

Based on provisions within your Provider Services Agreement, Molina requires compliance with all applicable state Medicaid laws and regulation, which includes compliance with the above-mentioned Appropriation 211 of the 22/23 GAA. Accordingly, it is the responsibility to use these additional funds to raise wages of any employee who provide direct care under the FL Medicaid Program. In alignment with AHCA, Molina has updated appropriate fee schedules to reflect rate increases as a result of the additional funding received from the 23/23 GAA effective 10/1/22 through 6/30/2023.

By submitting claims on behalf of FL Medicaid members and accepting payment for services provided, you are certifying and accepting compliance with Appropriation 211 of the 22/23 GAA. Molina reserves the right to conduct audits to validate compliance and pursue any overpayments as a result of non-compliance, fraud, waste, or abuse.

Should you have any questions, reach out to us at MFLProviderNetworkManagement@MolinaHealthcare.com as Molina is committed to partnering with you in working together to solve problems quickly and efficiently. 

You Matter to Molina is our new program designed specifically for finding new solutions and simplifying ways for providers to engage with the health plan. Please take a few minutes to visit You Matter to Molina and provide feedback.

For LTC Providers:

Pursuant to Specific Appropriation 222 of the 22/23 General Appropriations Act (GAA), the Agency for Health Care Administration (AHCA) received state finding for the sole purpose of raising wages of direct care employees of Medicaid providers including 1099 direct care employees who provide services under the Florida Medicaid Program. As required, providers should have entered into a supplemental wage agreement with AHCA, which requires each provider to agree to pay each of its employees, who provide services under the Florida Medicaid Program, at least $15.00 per hour.

Based on provisions within your Provider Services Agreement, Molina requires compliance with all applicable state Medicaid laws and regulation, which includes compliance with the abovementioned Appropriation 211 of the 22/23 GAA. Accordingly, it is the responsibility to use these additional funds to raise wages of any employee who provide direct care under the FL Medicaid Program. In alignment with AHCA, Molina has updated appropriate fee schedules to reflect rate increases because of the additional funding received from the 23/23 GAA effective 10/1/22 through 6/30/2023.

By submitting claims on behalf of FL Medicaid members and accepting payment for services provided, you are certifying and accepting compliance with Appropriation 222 of the 22/23 GAA. Molina reserves the right to conduct audits to validate compliance and pursue any overpayments as a result of non-compliance, fraud, waste, or abuse.

Should you have any questions, reach out to us at MFLProviderNetworkManagement@MolinaHealthcare.com as Molina is committed to partnering with you in working together to solve problems quickly and efficiently. 

You Matter to Molina is our new program designed specifically for finding new solutions and simplifying ways for providers to engage with the health plan. Please take a few minutes to visit You Matter to Molina and provide feedback.

Molina Healthcare strives to improve HEDIS scores year-round through the collection and reporting of data. To achieve high HEDIS scores, the collection of medical records must occur multiple times throughout the year. Molina is interested in strengthening our relationship with provider groups by utilizing EMR Remote Access method to efficiently retrieve the necessary records to meet HEDIS requirements.

Benefits from EMR Remote Access:

• Reduction in time and office resources
• Removing the need for multiple outreaches from our team to yours
• Mitigating COVID-19 risks associated with going on-site

In order to fulfill our state and federal accreditation requirements regarding HEDIS and Risk Adjustment quality reporting, it is necessary for Molina to collect medical record data year-round.

By providing Molina Remote Access to HEDIS data, Molina can simplify the record collection process for the office staff. EMR access ensures Molina receives the required records in a timely manner to properly obtain HEDIS and contract compliance for the selected members.

We are striving for a collaborative relationship; therefore, your Intervention specialist is readily available to offer any help. You can also reach out to a HEDIS Specialist at: RegionDHEDIS@MolinaHealthCare.Com.

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:

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

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