Claims & Appeals
- Submitting Claims
As a participating provider with Molina Healthcare, you have established a contractual agreement to provide physical, behavioral and/or other long-term support services to our members. The arrangement is fee-for-service for the provision of covered healthcare services unless otherwise specified under your Participating Agreement. The rates established in your Participating Agreement are considered full payment for covered services provided. Accordingly, Molina Healthcare members may not be balance billed for any remaining amounts and/or difference between what is billed, and your negotiated reimbursement rates defined in the rate exhibit of your Participating Provider Agreement.
Molina Healthcare pays clean claims submitted for covered services provided to eligible members. In most cases, we pay clean claims within 30 days.
How do I submit my claims to Molina Healthcare?
We recommend that you submit claims through the Electronic Data Interchange (EDI) for efficient processing and payment. We work with SSI Claimsnet for all EDI transactions.
When submitting your 837 (I & P) files, please use our Payer ID: MLNIA.
Submitting electronic claims
Molina Healthcare offers a direct submit/web-based claims option through Availity. This functionality is available via the provider portal on our website. There is no charge to participating providers for submitting claims through the Availity tools. Availity supports keyed entry of claims on the portal and supports secure transfer/upload of batch claim files from most practice management systems. You must register with Availity to use the service and add Molina Healthcare as one of your payers. If you are not currently registered with Availity please visit www.availity.com to get connected.
If you have question, contact the provider services contact center at (844) 236-1464.
Processing and payment of claims for covered services are generally made within 30 calendar days of receipt of a clean claim. For more information on claims submission and payment, please refer to the Molina Healthcare provider manual.
- Submitting appeals on behalf of your patients
Provider may file appeals and/or grievances on behalf of a Molina Healthcare member with the member’s written consent.
To file an appeal or grievance:
- Email: Iowamemberappealsgrievances@molinahealthcare.com
- Fax: (833) 832-1922
- Phone: (844) 236-0894
- Mail:
- Appeals & Grievances
- Molina Healthcare of Iowa, Inc
- PO Box 39010
- Des Moines, IA 50393
We will make our appeal decision and send to you in writing within 30 days of receipt of the request. Expedited appeals will be resolved within 72 hours.
A grievance on behalf of a Molina Healthcare member must be filed within 60 days of the event. We resolve routing complaints immediately. However, we may need to ask you to submit additional information. In that case, you will have 14 days to get us the information. We will notify the member and/or the representative within 30 days of the grievance filing or 44 days if an extension was granted.