As a participating provider with Molina, 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 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. Ninety percent (90%) of all Clean Claims from Providers, who are an individual or group practice or who practice in shared health facilities, are paid within thirty (30) Calendar Days of the date of receipt.
How do I submit my claims to Molina?
We recommend that you submit claims through the Electronic Data Interchange (EDI) for efficient processing and payment. We work with Change Healthcare for all EDI transactions.
When submitting your 837 (I & P) files, please use our Payer ID: MLNNV.
Molina 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 as one of your payers. If you are not currently registered with Availity please visit www.availity.com to get connected.
Molina Healthcare of Nevada, Inc.
PO BOX 22666
Long Beach, CA 90801
If you have question, contact the claims department at (833) 685-2103.
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 provider manual.
Molina Healthcare Inc.
Attn: Provider Appeals and Grievances
PO Box 401825
Las Vegas, NV 89140
We will make our appeal decision and send it 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 member must be filed within 60 days of the event. We resolve to route 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 would notify the member and/or the representative within 30 days of the grievance filing or 44 days if an extension was granted.