Partner With Molina in Arizona

Thank you for your interest in joining the Molina Healthcare (Molina) provider network. We appreciate your dedication to delivering quality care to patients, including those in our Arizona Medicaid and Medicare DSNP plans.

Note: To join Molina’s Medicaid network in Arizona, you must first be enrolled as an Arizona Medicaid Provider through the Arizona Health Care Cost Containment System (AHCCCS)

• Individual practitioners, physicians and provider groups, please complete the AzAHP Practitioner Form
  • Group practices with under 20 providers must fill out a provider information form for the group and separate provider information form for each licensed practitioner in the group.
  • Group practices with more than 20 providers can submit a provider information form for the group and include a roster listing each practitioner in the group with the same individual provider data for each individual as required on the provider information form (e.g., practitioner’s name, degree type, individual NPI, CAQH number, date of birth, provider type or specialty).
• If you are registered with AHCCCS to provide services as a facility or organization, please complete and submit the AzAHP Organizational/Facility Form and include a separate, completed organization application supplement form for each additional service location.

Submit completed forms with a current W-9 to the MCC provider network team at MCCAZ-Provider@molinahealthcare.com or fax (888) 656-0369.

For help, call our provider contact center at: (800) 424-5891.