Become a Molina Healthcare network provider

As a managed care leader, Molina Healthcare values our network providers and realizes your time is best spent with members—not with excessive administrative tasks.

We’re dedicated to delivering high-quality healthcare and helping Molina members get the most out of their Virginia Medicaid benefits. One of the reasons we’re able to do that is because we partner with the very best providers. We’re proud to work with healthcare professionals who share our commitment to serving Molina members.

What are the benefits of being an Molina network provider?

We offer many solutions to save you valuable time and resources, including:

  • Simplified credentialing, most completed within 30-60 days
  • Tools, programs and education resources online
  • Streamlined electronic claims processing through electronic data interchange, direct claims submission and electronic funds transfer
  • Prompt claims payment
  • Access to provider support specialists, all of whom are licensed nurses and behavioral health clinicians who offer training and technical assistance to providers to promote best practices and improve quality of care

We work with our local provider associations, including 40 Virginia Community Service Boards such as Norfolk and Horizon Behavioral Health, and the Virginia Nursing Association to better understand the specific challenges providers face in the development of new programs or when policies are changed. By learning from our partners and sharing our collective experiences and resources, we can tailor our services to more effectively and efficiently help you. For example, we modified our training materials based on feedback from providers and enhanced our claims testing practices to accommodate nursing facilities.

We offer live webinars and onsite training, led by our Provider Support Specialists, further supplemented by our virtual provider training and provider resources on our provider website. We expand on this curriculum with ongoing training updates, program updates and annual training requirements.

We give network providers the opportunity to guide and influence Molina's policies through ongoing dialogue in provider focus groups, regional and local meetings, and the provider advisory committee. Take advantage of ongoing support and technical assistance, and stay up to date through our newsletter, website, webinars, weekly open forum conference calls, town hall meetings, and elearning.

We conduct regular claims training sessions for the first 12 months following implementation, and we provide ongoing claims training, per the needs of the provider network, throughout the life of the contract.

What are the Molina network requirements?

To join the Molina provider network, individual providers, group practices and provider organizations must first be enrolled (including signing a Department Medicaid provider participation agreement), and re-validate as required in the Department’s MES PRSS enrollment. Molina will terminate the provider’s agreement immediately upon notification from the State advising if the network provider cannot be enrolled or re-validated. Additionally, prior to signing or execution of a Molina contract, we ensure all practitioners and organizations meet specific credentialing criteria and are approved by Molina’s Regional Network and Credentialing Committee (RNCC).

What does the Molina credentialing process include?

The Molina credentialing process includes three main steps:

  • Application review—Molina confirms you have fully completed the application and supplied all required supporting documents.
  • Verification of credentials—Molina verifies information including, but not limited to, license status, insurance coverage, and education/training using criteria defined to meet accreditation, regulatory and other applicable requirements.
  • Committee review—If your credentials meet the minimum required standards, the application is sent to an RNCC comprised of Molina clinical staff and professional peers. The RNCC reviews applications subject to business needs and in accordance with applicable state laws.

How long does the credentialing process take?

Once all required documents have been submitted, credentialing and contract execution/activation can occur. Over 90% of the time, we complete the process within 60 days after receipt of all necessary information.

Are you ready to join the Molina provider network?

Step 1 – Complete our Virginia Guide to Provider Forms

  • Individual practitioners and/or group practices
    If you are an individual provider or a group of providers who perform medical services, please complete and submit the Virginia Guide to Provider Forms.
    • Group practices must fill out one Virginia Guide to Provider Forms for the group and one for each licensed practitioner in the group.
    • Group practices with over 50 providers can submit one Virginia Guide to Provider Forms for the group and a roster listing each provider in the group. The roster must include the following information: provider’s name, degree type, individual National Provider Identifier (NPI), Council for Affordable Quality Healthcare (CAQH) number, date of birth, and provider specialty.
    • Group practices that employ nurse practitioners must complete a Virginia Guide to Provider Forms for each nurse.
  • Organization and facility providers
    If you are licensed by the Commonwealth of Virginia to provide services as a facility or an organization (this includes Durable Medical Equipment (DME) providers), please complete and submit the Organization Provider Application Form.
    • Complete the Organization Provider Application for the primary site and complete a separate Organization Application Supplement form (included in the application) for each of additional service locations.
  • Individual service facilitators
    Are you an individual provider that is licensed by the Commonwealth of Virginia to provide long-term support or ancillary services? If so, please complete and submit the Individual Service Facilitator Application along with a Virginia Guide to Provider Forms.

Step 2 – Submit your completed forms
Submit your Interested Provider Form along with an IRS W-9 tax form to our Molina provider network team. All submissions must include the name of a primary contact person along with an email address and/or phone number.

You can submit your completed forms any of the following ways:

Step 3 – A Molina provider network representative will review your initial application and contact you.