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Welcome, Florida Healthcare Providers
Contracted providers are an essential part of delivering quality care to our members. As our partner, assisting you is one of our highest priorities. We look forward to supporting your efforts to provide quality care. If you have questions, call Provider Services at 1-855-322-4076 or click below to register for one of our upcoming educational events:
Come join us and learn more about Molina Healthcare!!!
Molina Healthcare will provide Provider Trainings every THIRD Thursday!
New to Molina's provider network? Looking for a refresher?
Thursday, September 21, 2023
10:00 AM – 11:00 AM EST
In these informative sessions, you'll get an overview of Molina and get the opportunity to ask us your questions.
For more information click HERE.
Provider Orientation/General Information Schedule
September 21, 2023 | 10 - 11 AM EST | REGISTER → |
October 19, 2023 | 10 - 11 AM EST | REGISTER → |
November 16, 2023 | 10 - 11 AM EST | REGISTER → |
December 21, 2023 | 10 - 11 AM EST | REGISTER → |
Click HERE for Availity Training Dates in September and October!
PLEASE CHECK BACK FOR MORE TRAINING DATES
If you have any general comments or suggestions on how to make your training experience better, please click HERE to complete one of our provider surveys.
YOU MATTER TO MOLINA!!
***ATTENTION*** ***MINIMUM WAGE REQUIREMENT - GAA***
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.
Electronic Medical Records Access
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 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 FLP.O. BOX 22812
Long Beach, CA 90801
Please Note: As of January 15, 2020, disputes received for denial reasons stated above will be rejected.
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
It is important that your provider directory demographics are accurate. Visit our Provider Online Directory to validate your information and notify us of 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)