Need a Prior Authorization?
* When Prior Authorization is 'Required', click here to create Service Request/Authorization
PA Lookup tool is under maintenance.
Please refer to the state specific Excel matrix while the PA Lookup Tool is disabled.
The information below 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.
As of Feb. 1, 2023, Provider Services no longer accepts claim disputes via email. All claim disputes for a denial, payment amount, or code edit must be submitted following the Provider Claim Dispute Process. More information can be located in the January Provider Bulletin here.
Providers no longer have direct access to the Molina Legacy Provider Portal. We encourage you to register with Availity here.
Molina posted the Ohio Medicaid-specific clinical policies on our Medicaid Provider Website here.
The current PA Code List became effective April 1, 2023. View it here. View the Q3 PA Code List, effective as of July 1, 2023, here.
Next Generation Medicaid Information:
The Medicaid Provider Manual, effective as of Feb. 1, 2023, is posted here.
Do You Have Your OH|ID? As of Oct. 1, 2022, all Medicaid providers need an OH|ID. Providers must obtain an OH|ID to access the PNM or Single Pharmacy Benefit Manger (SPBM) web portal and do business with Ohio Medicaid. Get your OH|ID today here.
Based on guidance from ODM for the Next Generation Medicaid, Molina began denying claims submitted by non-enrolled or inactive providers on Feb. 1, 2023. Learn more here.
Credentialing Reminder: As of Oct. 1, 2022, ODM is the single point of contact for provider credentialing for Medicaid and MyCare Ohio via the new Provider Network Management (PNM) module. Find out more in the October 2022 Provider Bulletin, posted here.
PNM Training: ODM PNM provider resources (no log in required) are available hereor visit the ODM website to register for a self-paced training session or sign up for virtual and/or in-person learning here.
SPBM Training: Visit the Gainwell website to view Pharmacy Web Portal training or Prescriber Web Portal training. Find the Gainwell website here.
ODM Press: Read the ODM Press here to stay updated on upcoming Next Generation Medicaid changes and visit the ODM Next Generation Medicaid Providers page here. Subscribe to the ODM Press here. For questions about the Next Generation program, contact ODMNextGen@medicaid.ohio.gov.
Medication Assisted Treatment
Molina Peer Support Program
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.
Your Opinion Matters to MolinaEmail us to share your comments, concerns or ideas. Your feedback is important to us. Let us know what we're doing well and what we can do to improve.
Molina Healthcare of Ohio's "It Matters 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 “It Matters to Molina” program, we have a dedicated Provider Services 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.