Molinalogo

• Step One - Connect

  Points of contact and the process for joining our network will differ depending on the type of provider that you are. Please follow the instructions below for your provider type:

   

  Medical Providers

  Please submit a Contract Request on our online provider portal.

  Long-Term Services & Supports (LTSS) Providers

  Wisconsin’s Long-Term Services & Supports programs include Family Care and Family Care Partnership, which provide home and community-based services and integrated care for older adults and individuals with disabilities who need assistance with daily living activities. For additional information, please visit Long-Term Care and Support | Wisconsin Department of Health Services Please submit a Contract Request on our online provider portal.

  Dental Providers

  Molina Healthcare of Wisconsin dental network participation varies by line of business. Dental services for Medicaid, including BadgerCare Plus and Medicaid SSI, and Medicare Advantage, including Dual Advantage / D-SNP, are administered through Molina’s dental vendor, Skygen. To become a DentaQuest dental provider, please contact: Phone: (844) 870-3977 Website: DentaQuest.com If you are unsure which dental contracting process applies, please contact Provider Network Management before submitting your request.

  Vision Providers

  Molina Healthcare of Wisconsin covers both medical and routine vision services. Routine vision services are administered through Vision Service Plan (VSP) for applicable lines of business. To provide both medical and routine vision services to Molina members, providers must contract with both Molina and VSP. To contract with Molina Healthcare of Wisconsin, please submit a Contract Request on our online provider portal. To contract with VSP, please visit the provider page at VSP.com or call (916) 851-4165. Molina Healthcare of Wisconsin. Please submit a Contract Request on our online provider portal. Note: Practitioner groups that include optometrists must be contracted with VSP to provide routine vision services to Molina members. If you are unsure which vision contracting process applies, please contact Provider Network Management before submitting your request.

  Pharmacy Providers

  Please contact our Pharmacy benefits manager, CVS Pharmacy, by visiting Join CVS Caremark Network or by calling (800) 364-6331.

   

   

• Step Two - Documentation

  If your Contract Request is accepted, you will receive login credentials to the online portal to provide additional information to complete both the contracting and credentialing processes.

  
  

  Provider information and documents you may be asked to provide in the portal may differ depending on provider type, and may include, but are not limited to:

  • W-9 Form
  • CAQH Application or Molina Credentialing Application, depending on practitioner or organization type
  • Current state license(s) and certifications, as applicable to provider type
  • Proof of Wisconsin Medicaid ForwardHealth enrollment and Medicaid ID Number(s), when applicable
  • Certificate of Insurance
  • Disclosure of Ownership and Control Interest Statement (DOHCI) or equivalent ownership documentation
  • Board certification or education/training documentation, if applicable to specialty
  • HCBS compliance documentation, for applicable waiver/LTSS providers
  • Molina Roster File
    (the preferred roster template will be available in the online portal after you receive your login credentials)

  
  

   

  Upon completion of your online application, Provider Network Management will then begin the network enrollment process and initiate contracting, including sending a Provider Agreement for review and signature. Final execution of the agreement is contingent upon successful completion of credentialing.

• Step Three - Credentialing

  Providers must meet credentialing requirements.
  For provider types that require credentialing, please ensure that you have a complete CAQH application. This means:

  • Your application is in a completed status
  • You have authorized Molina to view your data
  • You have attested in the last 120 days
  • All your documents are completed and not expired

   

  Credentialing requirements for Health Delivery Organizations (HDOs)

   

  All HDOs will need to provide their state license(s) and applicable accreditations and certifications to be credentialed. A site visit may also be required for your facility.

  
  

  Once your request to join the network is accepted, you will be provided login instructions to upload your credentialing documents in the Provider Network Management Portal.

   

• Step Four - Contract

  The final step in the onboarding process is execution of the Provider Agreement.

  Once credentialing and contracting requirements are completed:

  • Molina will issue a Provider Agreement for signature.
  • After all required signatures are obtained, Molina will countersign the agreement and provide a fully executed copy to the provider.
  • Credentialed facilities and/or practitioners will be loaded into Molina’s claims payment system as in-network providers.

  The in-network effective date for each facility and/or practitioner will be based on the effective date outlined in the fully executed Provider Agreement or completion of credentialing requirements, as applicable, and will be communicated in the participation notification.

  Providers will use the Provider Network Management Portal, to track contracting and credentialing status, receive requests for additional information, and view updates related to onboarding and network participation.

Already Contracted Providers

Are you a contracted Provider with Molina Healthcare and need to add practitioners to your existing practice?

Login to the Provider Network Management portal to add a practitioner or upload a roster.

• First time user of our new online provider portal? Please click here to receive a username and password to update your information.
• Existing users of our online provider portal: Please click here to access our online provider portal to update your information.

Updating Provider Information

Are you a contracted Provider with Molina Healthcare and need to make changes to your provider information?

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
• Termination of a provider
• Change in Tax ID and/or NPI
• Open or close your practice to new patients

Providers should submit their change requests to MHWIProviderNetworkManagement@Molinahealthcare.com

Questions?

For more information on Molina Healthcare, please review the applicable Provider Manuals.

If you have any questions, please contact Provider Services:

• Medicaid SSI, BadgerCare Plus: (855) 326-5059
• Medicare Dual Advantage, Family Care, Family Care Partnership: (800) 963-0035