Molinalogo

Thank you for your interest in joining Molina Healthcare of Massachusetts's provider network. Currently, we provide coverage to SCO/One Care (Dual Eligible) members in the State of Massachusetts. Contracted providers are an essential part of delivering quality care to our members, and we value our partnerships with our providers.

Effective 8/24/26 Molina will be transitioning to an external provider portal to manage new and existing provider requests. Delegated providers should continue current process.

Note: To be a contracted provider with Molina Healthcare of Massachusetts, you must register with the state here. 

Required for all providers

• Must be Located and/or Performing Services in the State of Massachusetts
• Malpractice Liability Insurance
• Valid W-9
  
  

All Providers with the Exception of LTSS, Dental, Vision, and Pharmacy

Please submit a Contract Request on our online provider portal.

Long Term Support Services (LTSS)

Long Term Support Service (LTSS) providers are available to eligible MassHealth members to enable them to live with independence and dignity and participate in their communities.

Please visit mass.gov/masshealth-ltss-programs-and-services for more information.

If you are one of these providers, please submit a Contract Request on our online provider portal.

If your Contract Request is accepted, you will be asked to provide additional information in our online provider portal to complete both the contracting, and credentialing processes. Provider information and documents you may be asked to provider in the portal may differ depending on provider type, and may include:

• Ownership and Control Disclosure Form
• W-9
• Practitioner Information
• Medicaid Identification Numbers (s)
• Molina Roster File
  
  

Find these documents on our Frequently Used Forms page. Upon completion of your online application the Molina Network team will then begin the network enrollment process and send you a Provider Agreement for signature.

Step Three-Credentialing

Providers must meet credentialing requirements. For provider types that require credentialing, please ensure that you have a complete CAQH application. This means:

• Your application is in a completed status
• You have authorized Molina to view your data
• You have attested in the last 120 days
• All your documents are completed and not expired
  
  

Step Four-Contract

The final step will be for Molina to countersign your Provider Agreement and provide you with a signed copy. Credentialed facilities and/or practitioners will also be loaded into Molina's claims payment system as in-network providers. The in-network effective date for each facility and/or practitioner will be the date of credentialing completion, which will be included in the notification you will receive from Molina.

Adding practitioners to your existing practice or making changes to your provider information? 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 of close your practice to new patients
  
  

Are you a contracted Provider with Molina Healthcare and need to add practitioners to your existing practice? Login to the Provider Network Management portal to add a practitioner or upload a roster.

First time user of our new online provider portal? Please click here to receive a username and password to update your information.

Existing users of our online provider portal: Please click here to access our online provider portal to update your information.

Dental Providers

Molina Healthcare of Massachusetts provides dental services to members through DentaQuest. To become a dental provider, please contact (844) 870-3977 or visit DentaQuest.com.

Vision Providers

Molina Healthcare of Massachusetts provides vision services through VSP. To contract with VSP, please visit the provider page at VSP.com or by calling (916) 851-4165.

Note: Practitioner groups that include optometrists must be contracted with our vendor in order to contract with the Health Plan.

Pharmacy Providers

Please contact our Pharmacy benefits manager, CVS Pharmacy, by visiting Join CVS Caremark Network or by calling (800) 364-6331.

You take care of your patients. Let Molina take care of the rest.

At Molina, we’re proud to work with providers who share our mission to maximize the health, security and independence of Massachusetts seniors. Our comprehensive team-based model of care allows us to collaborate more fully with network PCPs, specialists and community service providers to individualize member care plans that are adaptable to the changing needs of each member.

Why join the Molina network

We’re committed to offering our providers benefits that allow you to concentrate on caring for your senior patients. Some of the ways we help you to help our members include:

• Helping to reduce your administrative burden with:
• A single payment source (no secondary billing required)
• No deductibles, copays or coinsurance to collect
• No referrals to in-network providers
• No PT-1 forms required for transportation
• Access to SWH pharmacist for assistance with medication management
• Working closely with you to help plan and coordinate medical, behavioral, pharmaceutical and social services for members. Every member gets a Nurse Care Manager who bridges the gap between the member and their providers.
• Providing a secure 24/7 Provider Portal that allows you access to claims, member eligibility and more.



Provider Portal




(For dates of service starting 1/1/2022)

 

 

• The Credentialing Process

  Our credentialing team will review and process your request. We may contact you to obtain additional information required to complete your application.  If you are a solo practitioner or part of a non-participating group, you will be required to sign a Molina Provider Agreement. A representative from our Provider Services Department will contact you regarding your next steps.

  Please note: Molina cannot guarantee that requesting providers will become contracted providers. Providers are subject to reviews based on network adequacy and Molina qualification standards.

  Credentialing is finalized when approved by the Medical Advisory Committee and by the return of a countersigned Agreement (if applicable) along with an accompanying letter identifying you as a credentialed provider.

• In order to prescribe Part D drugs to Medicare patients, you must be enrolled as a
  Medicare and Medicaid provider.

  Learn more about enrolling in Medicare as a Molina Provider.
  
  To securely and electronically submit and manage Medicare enrollment information, visit the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
  
  If you have questions, please contact Provider Services at:
  Phone: (855) 838-7999
  Email: SWH Provider Relations