Electronic Data Interchange (EDI) functionality is utilized by Molina to complete several types of ASC X12N Version 5010 transactions, including:
Claims Submission (837 Professional and Institutional Healthcare Claims)
Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) – (835 Healthcare Claim Payment/Advice)
Referral Certification and Authorization (278 Healthcare Services Review - Request for Review and Response)
Eligibility for a Health Plan (270/271 Healthcare Eligibility Benefit Inquiry and Response)
Claims Status (276/277 Healthcare Claim Status Request and Response)
EDI claims submission The easiest way to submit EDI claims to Molina is through a clearinghouse. You may submit the EDI claims through your own clearinghouse or use Molina's contracted clearinghouse (see the Clearinghouse Information section for Payer ID information). If you do not have a clearinghouse, Molina offers additional electronic claims submissions options. Log on to Availity's Provider Portal for additional information about claims submission options available to you.
270/271 Healthcare Eligibility Benefit Inquiry and Response & 276/277 Healthcare Claim Status Request and Response
Molina does not directly exchange 270/271 and 276/277 transactions. The 270/271 and 276/277 transactions are handled by our contracted clearinghouse Change Healthcare. The transactions may be sent directly to Change Healthcare or via your own clearinghouse.
278 Referral Certification and Authorization Form
The 278 Request transaction is utilized to verify medical necessity for health care services; therefore, additional supporting documentation may be necessary for approval of requested services.
Can I submit COB claims electronically?
Yes, Molina and our connected Clearinghouses fully support electronic COB.
Do I need to submit a certain volume of claims to send EDI?
No, any number of claims via EDI saves both time and money.
Which Clearinghouses are currently available to submit EDI claims to Molina?
See Clearinghouses section.
What claims transactions are currently accepted for EDI transmission?
837P (Professional claims), 837I (Institutional claims).
Where can I find more information on the HIPAA transactions?
See Companion Guide section.
How do I exchange the 270/271 Eligibility Inquiry?
Molina does not directly exchange the eligibility transactions. The transactions may be sent to Molina's contracted clearinghouse Change Healthcare to verify eligibility.
How do I exchange the 276/277 Claim Status Inquiry/Response?
Molina does not directly exchange the claim status transactions. The transactions may be sent to Molina's contracted clearinghouse Change Healthcare to verify Claim Status.
What do I do if I still have questions?
See Contact Us section below.