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We're Glad

you're part of
the Molina Family

“I love working with Molina, their claim department is responsive and efficient”

Dr. Marina Jones

 
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The COVID-19 pandemic is rapidly evolving. Molina would like to share resources and updates with our providers. Learn More.

Welcome, Molina Dual Options Healthy Connections Prime Providers!

Become a Molina Dual Options Provider

Contracted providers are an essential part of delivery quality care to our members. We value our partnership and appreciate the family-like relationship that you pass on to our members.

As our partner, assisting you is one of our highest priorities. We welcome your feedback and look forward to supporting all your efforts to provide quality care.

If you have any questions or if you are interested in becoming a Molina Dual Options provider, please call Provider Services at (855) 237-6178.

Provider Services Portal

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Molina Dual Options Provider Self Services has a variety of tools to simplify your transactions whether you need to check eligibility or check claim status. For more information contact Provider Services. Molina Dual Options is now collecting National Provider IDs (NPIs) from contracted and non-contracted providers. Submit your NPI to Molina via our Provider Self-Services Portal.

Medicare Compliance Program

Medicare Compliance Training

Model of Care Training Materials

Please click here for the Model of Care Training Materials.

April 2021 Prime Stakeholder Update

Please click here for the April 2021 Prime Stakeholder Update from SCDHHS.

Prior Authorization (PA) Updates

Prior Authorization Code Matrix

Prior Authorization Guide

Prior Authorization Request Form

BH Prior Authorization Request Form

Opioid Treatment Program Information

Please click here for more information on the Opioid Treatment Program.

 

AUTHORIZATION FAX NUMBER CHANGES

Effective April 5, 2021, Molina Dual Options Medicare-Medicaid Plan and Molina Medicare Complete Care HMO SNP implemented a change in fax  numbers for submission of  prior authorization requests. The new fax numbers are  listed below.

Molina Dual Options:

  • Outpatient & Elective Inpatient: (844) 251-1451
  • Inpatient Admission Notification & Concurrent Review: (844) 834-2152

Molina Medicare Complete Care:

  • Outpatient & Elective Inpatient: (844) 251-1450
  • Inpatient Admission Notification & Concurrent Review: (844) 834-2152

This is only a change in the fax numbers utilized to submit for prior authorization and/or notification of admission and clinical for UM review.  

ACR Information

Molina has incorporated American College of Radiology (ACR) guidelines into Molina's criteria of clinical decision support for advanced imaging. For more information contact Provider Services at (855) 237-6178 or email at click here

ICD10 Implementation Update

Molina Healthcare has fully implemented ICD-10. Have questions? Looking for additional information? Learn more.

Going Green

Reminder: Molina Dual Options has gone green and all claims need to be submitted through an EDI Clearinghouse or via Molina Dual Options Provider Portal. Please contact our Provider Services team if you have any questions

Important Reminder

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 or close your practice to new
       patients (PCPs only)
​