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Provider payment & recovery policies

Billing, coding, and reimbursement policies for providers help identify and correct improper payments through the detection and collection of overpayments, and the identification of underpayments to providers regarding claims. This enables Molina to implement actions and system improvements that will ensure correct payments in the future.

Payment support

Choose the line of business that you are submitting a bill to view the correct policies. For Medicare and individual and family plans (Marketplace), Molina utilizes enterprise-wide policies. Select the applicable line of business below. Individual and Family Plans (Marketplace).

 

All Forms & Documents

For claims submission and portal access:

Register for the Availity provider portal

Clearinghouse connection:

Register with the SSI Group using the Claimsnet provider registration form.

ERA/EFT:

Register for EFT/835

More Resources

Claims and Payments

If you submit claims electronically, you may key claims through the Availity provider portal: Availity.com or connect through SSI Group: SSI Group.

Molina also accepts electronically submitted claims through your existing clearinghouse connections, including Optum-Change Healthcare, SSI Group, UHIN, TMHP, COBA, or directly via the Availity Essentials provider portal.

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