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Making Changes? Please notify Molina Healthcare at least 30 days in advance when you:
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Prior Authorizations Pre-Service Review Guide
Medical Prior Authorization Request Form
Pharmacy Prior Authorization Form
Behavior Health Prior Authorization Form Prior Authorization Codification List - 2022 - Q3
Prior Authorization Codification List - 2021 - Q2
Prior Authorization Codification List - 2021 - Q1
Prior Authorization Codification List - 2020 - Q3
Prior Authorization Codification List - 2020 - Q2
Prior Authorization Codification List - 2020 - Q1
Illinois Hospital Health Care System Service Area Map
Illinois Service Area - Ancillary
Illinois FQHCs, RHCs, and ERCs
Molina Authorized Representative Designation Form
Molina Claim-Issue Template (download)
CAQH Form
Claims Dispute Request Form
Health Delivery Organization (HDO) Form
Open Panel Form
Patient Change of Address Form
Pregnancy Notification Form
Provider Contract Request Form
Provider Information Update Form
Provider Memo: Improve Service and Increase Efficiency: Enroll in EFT/ERA
Provider Profile and EFT Registration Form
Request to Change PCP Form
Universal IAMHP Roster Template (download)
W-9 Form
Availity - How To Open A Support Ticket
Availity Core Features
Availity Functionality Roadmap
Critical Incident Reference Guide
FQHC Encounter Clinic Billing Quick Reference Guide
Guide to HFS MEDI Eligibility Search
Marketplace Providers FAQ
Marketplace Providers Quick Reference Guide
Guide to Provider Changes
Open Enrollment Guide
Patient Health Resources
Provider Roster Template Frequently Asked Questions
Quick Reference Contact Sheet
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