Partner With Molina in Ohio

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

Note: Before applying to join Molina’s provider network, you must first be enrolled with and hold an active Medicaid ID from the Ohio Department of Medicaid’s Provider Network Management (PNM) system

• Medical providers can submit a completed Provider Contract Request Form to OHContractRequests@MolinaHealthcare.com or fax to the attention of Provider Contracts at (866) 384-1226.
• Dental providers can submit a completed Dental Provider Contract Request Form to Denta.VisionDevelopment@MolinaHealthcare.com.
• To add new providers to a participating group please submit a complete Provider Information Update Form (PIF) via email to: MHOProviderUpdates@MolinaHealthcare.com. Dental providers should email their form to: MDVSPIM@MolinaHealthcare.com.

Questions?

Email Provider Contracts at OHContractRequests@MolinaHealthcare.com.

Your collaboration is vital, and we value your partnership.

Provider Contract Templates

Molina Healthcare Provider Services Agreement

Molina Healthcare Hospital Services Agreement

Molina Healthcare Dental Provider Services Agreement

Non-Contracted Practice/Group Information

Ohio Provider Contract Request Form

Ohio Provider Contracting Guide

ODM Designated Provider and Non-Contracted Provider Guidelines

Ohio Dental Provider Contract Request Form