Molinalogo

As a participating Molina provider, you agree to bill all covered services provided to Molina members on the required forms and/or electronic claims file format. All claims should be billed on a fully completed CMS 1500, UB04 and/or CMS 1450 to be considered for adjudication and/or payment. You may visit the Centers for Medicare and Medicaid Services (CMS) website at www.cms.hhs.gov to obtain more information about these forms and/or for more instruction and/or information on the proper use of claims forms for services.

Any claims requiring authorization should include the authorization number in the appropriate field of the CMS 1500, UB04 or CMS 1450 to assist with appropriate claims processing and timely claims payment. Download this list of services requiring prior authorization (coming soon). A reference to the listing is also located in Section 10: Medical Management of the Molina provider manual.

Claims for services provided to Molina members should be submitting within six months (180 days) of the date of service unless otherwise agreed upon in the Participating Provider Agreement. If not otherwise defined in the Participating Agreement, and/or in the case of a non-participating provider who provides covered service to Molina members, claims must be received within twelve months (365 calendar days) to be considered for processing and payment.

There are three timely filing exceptions that Molina takes under consideration:

• Coordination of benefits—When an Molina member has a primary insurance, the primary insurance Explanation of Payment (EOP) or Medicare Summary Notice (MSN) is used to determine the timely filing deadline. For these claims, the time frame begins with the print date on the primary insurance EOP or MSN.
• Members with retroactive eligibility—When a member becomes eligible for a DMAS Medicaid program after the date of service, but their coverage is backdated to include the date of service, the time frame for timely filing begins on the date Molina receives notification from the enrollment broker of the member’s enrollment.
• Other (good cause)—Molina will consider exceptions on a case by case basis for other causes of filing delays, such as incorrect information provided by official sources.
  
  

Corrected claims, adjustments, or reconsiderations should be submitted within 180 days of the original claim paid date in order to be considered for reprocessing.

Processing and payment of claims for covered services are generally made within 30 calendar days of receipt of a clean claim. For more information on claims submission and payment, please refer to the Molina provider manual.