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Recent Updates 

ODM News:

IMPORTANT UPDATE: Per the Ohio Department of Medicaid (ODM), terminations to resume effective Jan. 23, 2024, for failure to complete Medicaid Agreement Revalidations in the Provider Network Management (PNM) module.

If you are currently due for a revalidation in the PNM module, it is imperative that you take immediate action to complete and submit your revalidation application to renew your Ohio Medicaid Provider Agreement. ODM will begin terminating providers who fail to complete their revalidation prior to their specified deadline, starting Jan. 23, 2024.

ODM resumed provider revalidation notices in June 2023 as part of the federally required unwinding process from the COVID-19 public health emergency. ODM issues a series of notices to any provider requiring revalidation with the first one delivered 120 days prior to your Medicaid agreement end date. Subsequent reminders are issued at 90 days, 60 days and a final notice at 30 days. If you receive a revalidation notice, it is imperative that you take action to complete your revalidation on time. All providers are subject to either three- or five-year time-limited provider agreements.

How do you know if you are due for revalidation?

1. Check your mail and email.

Revalidation reminder notices are mailed and emailed to providers who are due for revalidation prior to the end of their Medicaid agreement. The email will be sent from OHPNM@maximus.com to advise you of a revalidation notice in the PNM Correspondence folder. Please check your spam folder for this email.

2. View the Correspondence folder in the PNM module.

Revalidation notices are posted in the PNM module and can be accessed in the Correspondence folder. Please be sure to select the type of correspondence from the drop down (in this case <Enrollment Notices>), and search for the “Revalidation Notices.” Review the Accessing Communications with PNM Quick Reference Guide on the PNM module for step-by-step instructions.

NOTE: If you think you are due for revalidation but have not received notices, please login to the PNM module and verify that the primary contact information is accurate in accordance with your Ohio Medicaid Provider Agreement. All mailers and email notices are directed to the primary contact individual or address identified in the system.

If I am due for revalidation, what action do I need to take?

A “Begin Revalidation” option appears in the PNM Enrollment Action Selections 120 days prior to the Medicaid Agreement end date. This can be found under the “Manage Application”, “Enrollment Actions” option within the provider file. Review the Revalidation/Reenrollment Quick Reference Guide for step-by-step instructions.

For more information

For technical support or assistance, contact Ohio Medicaid’s Integrated Helpdesk (IHD) at 800-686-1516 and follow the prompts for Provider Enrollment (option two, option two) or email IHD@medicaid.ohio.gov. Representatives are available Monday-Friday, 8:00 a.m. - 4:30 p.m. Eastern time.

To learn more about the PNM module and Centralized Credentialing, visit the PNM and Centralized Credentialing page on the Next Generation website.

 

Molina News:

The Prior Authorization (PA) Code Updates by line of business, effective Jan. 1, 2024, are posted here under the “Prior Authorization Code Changes” header. Please utilize the PA Code LookUp Tool to search for codes that require PA.

The Medicaid Provider Manual, effective as of Jan. 1, 2024, is posted here.

The MyCare Ohio Provider Manual, effective as of Jan. 1, 2024, is posted here

The information below regarding EDI inquiries outlines the steps to take so Molina can thoroughly research and advise on the next steps. Molina requests that our providers also share this information directly with their EDI partners:

  • Providers should submit an issue ticket with their respective clearinghouse to research and resolve all EDI issues before submitting the issue to Molina.
  • For EDI issues that cannot be resolved by the clearinghouse, providers should:
    • Send EDI questions to Molina via a secure email to OHProviderRelations@MolinaHealthcare.com.
    • All EDI questions must include the following data elements to ensure the most efficient intake and research process: date of service, Molina member's full name, Molina member's ID number, billed amount, Pay To NPI, Rendering Provider NPI, and the Molina Payer ID used for submission of the transactions. 
 

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For more information call (855) 665-4623, TTY/TDD: 711, Monday - Friday from 8:00 a.m. - 8:00 p.m. local time and ask for our Care Management department.

  

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Molina Healthcare of Ohio's "You Matter to Molina" program prioritizes connecting directly with our network of over 90,000 providers and supporting their efforts to deliver high-quality and efficient health care for Molina members.

Through the “You Matter to Molina” program, we have a dedicated Provider Relations Team to intake and resolve your questions or issues and solicit input and feedback from you, our network providers and administrative staff, about ways Molina can improve our technology, tools and processes to minimize administrative hurdles and better support you. 

 

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