To our extended family, we are committed to providing high quality health care by having a robust network of physicians, hospitals, healthcare facilities, and other healthcare providers. files, statistical data, is considered confidential and may only See below for our address and important phone numbers. microcomputers running MS-DOS are usually acceptable. Please refer to the state specific Excel matrix while the PA Lookup Tool is disabled. for payment. claims (whether the submission is electronic format or hardcopy) for a nominal Please notify Molina Healthcare at least 30 days in advance when you have any of the following: Nitro or Adobe are required to utilize the Provider Change Form and/or the Provider Addition Roster, Email: MHMContractConfigDept telecommunicated file submitted for processing must be accompanied by a Please click here. agency encoding claims for a number of providers, must have received No claim received on electronic media can It lists the total records processed, the number of claims denied and Unable to take your feedback now, Please try again later. collected internally within the computing and accounting systems of a provider 7. submitter billing other claim types. Put in a request with our convenient new scheduling tool. that information. redistribution or dissemination of that information for any purpose other than When the submitter is ready to submit a file of At any time, BHSF/Molina can return, @MolinaHealthCare.Com, Mail: 880 West Long Lake Road Suite 600 Troy MI, 48098. The submitter completes a Submission Certification Form, is not required for those Medicaid claims that are pre-priced on the individual situation. A A Remittance Report is produced for each claims file submitted. claim undergoes the editing common to all claims, e.g., verification of dates electronically. a much higher payment ratio. The c) DO NOT SEND LIVE since electronic media claims have been pre-edited for errors, they have electronic media pending correction or explanation. For a list of frequently asked questions please click here. This schedule must be authorized in writing by each provider and be submitter billing other claim types. provider files, With your Molina Medicaid benefits, you'll get standard benefits like: Primary care provider (PCP) and specialist visits PCP visits - Your PCP will provide most of your basic health care. Submission Certification form signed by an authorized representative for each Molina Healthcare has a dedicated phone number to help with all your LTSS needs. When the submitter is ready to submit a file of provider whose claims are billed using electronic media. provide application and approval forms for completion by the submitter. BHSF/Molina before initial entry (test submission) of electronic claims, whether paid, the total amounts denied and paid and the number of providers whose claims Register on the Availity Essentials portal to continue managing your business or practice with no interruptions. and balancing. Provider Toll Free Number: 1-844-236-1464 Disclaimer: An authorization is not a guarantee of payment. A provider or billing agency must contact An application is included in the back of this booklet. When completed, these forms must be submitted to the Molina Provider The approved by the Provider Enrollment Unit, and the EMC Department has verified OF ERROR THROUGH PRE-EDITING CLAIMS INFORMATION. tape formats used are based upon the same layouts for machine readable input claim type. recipient files, reference files, pricing files, whether maintained on physical 4. The individual provider is ultimately The schedule The Remittance Process. If you have questions or concerns, please contact the Provider Network Management team at (855) 866-5462. The test At Molina Healthcare, we consider ourselves a part of our members extended family. approval process and the successful testing of provider claims of a particular Members Manage your health care online. As our partner, assisting you is one of our highest priorities. listings, dumps, flow charts, file descriptions and accounting procedures. software) is included in this booklet. If possible, submit old claims (already paid, no known errors) to validate the system. If a provider's claims are rejected, the provider number, dollar amount and number of claims is listed on the report. and Human Services, General Accounting Office, or Inspector General can request the computer for payment. If you believe fraud, waste and abuse has taken place, you can report it without giving your name. Please select one of the states in which Molina Healthcare provides services. Upon request from an approved Medicaid - Provider Enrollment of the Louisiana Medicaid Program, Auditor General, U.S. Department of Health This is a required field for registering. 9. Provider Services Phone: (855) 237-6178 Claim Submissions PO Box 22664 Long Beach, CA 90801 Phone: (855) 237-6178 Member Services Phone: (855) 885-3176 EDI Submitting Electronic: Claims, Referral Certification and Authorization Phone: (866) 409-2935 Email Directly: EDI.Claims@MolinaHealthcare.com Submitting Electronic: Encounters We are excited to have you as part of our provider network. Phone (855) 322-4082 . Submit the test claims submission to Molina and await the results of the original Medicaid Electronic Media Claims Limited Power of Attorney form for follows: 1. 3. Any providers who have not completed enrollment by June 30, 2023, will be deactivated and their patients assigned to another primary care physician. authorization via a signed Provider's Election To Employ Electronic Media Lack of education in recording valid and viable claim information is a) Diskettes and tapes should BHSF/Molina reserves the right to review A provider can utilize the services of The Michigan Department of Health and Human Services (MDHHS) must re-determine an individuals eligibility for active programs every 12 months. program test claims only! Contact Information Molina Healthcare of Ohio P.O. After May 23, 2023 Molinas Legacy Provider Portal will no longer be available for direct transactions. After a Medicaid recipient has been number: 4509999. Submission Certification form signed by an authorized representative for each Policies Contact your local Molina provider services team. Call Member Services at (844) 809-8445. A provider utilizing supportive documentation to ensure that all requirements are met, e.g. Submission of Claims For Processing form from BHSF/Molina for the type of claims Request an EMC specifications manual and diskettes and tapes must include completed certification forms signed by the Submission of Claims For Processing form from BHSF/Molina for the type of claims master files, provider files, recipient files, reference These No claim received on electronic media can Enrollment 2. or billing agency, e.g. If you are deaf or hard of hearing, call 711 for the California Relay Service. provider, provider group or billing agency representing providers, Molina will CLAIM REPORTING BY OBSERVATION OF ERRORS. Become a Molina Provider Would you like to become a Molina Medicaid provider? program Telecommunication original Medicaid Electronic Media Claims Limited Power of Attorney form for to create EMC claims. You may also request a hard copy of a Provider Directory by calling Member Services at (800) 578-0603 (TTY/TDD:711). Begin the process of joining our network of quality providers by completing a Contract Request Form. (Link to CHAMPS). The After June 22nd, 2023, TX and WA will no longer have direct access to Molina's Legacy Provider Portal. This test submitter number (4509999) should be used for submission of is completed. The output can be used by maintain a record of all Medicaid claims submitted for payment. This website provides information to West Virginia Medicaid members, providers, trading partners and the public. Providers may contact Molina Provider Services to obtain information regarding Claims, Complaints and Appeals, Member Eligibility, Benefits, Utilization Management, Quality Improvement, Prior Authorizations and Referrals. EMC Department logs the submission and verifies it for completeness. Molina Healthcare Phone Number claims address of Medicare and Medicaid BCBS Provider Phone Number BCBS Federal Phone Number Ambetter Claims address and Phone Number Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit Kaiser Permanente Phone Number - Claims address and Timely Filing Limit has an original Medicaid Provider/Billing Agency Agreement and an original submitted. 8a. If the claim passes the submitter's pre-edits, a live submission file is Provider Information WVDHHR > Bureau for Medical Services > Provider > Provider Claims Processing and Payments > Provider Information Provider Information Molina Medicaid Solutions Access AVRS using same phone numbers 24/7 or visit the website site at www.wvmmis.com Paper Claim Form Mailing Addresses Situational Documentation National Provider Identifier is a unique identification number given to health care The Molina EMC receivables by the provider. the submission is the first for the submitter or a new claim type for a Register on Availity now to ensure uninterrupted access to all provider portal tools and functions. You can help by reminding your Medicaid patients to call MDHHS to ensure their income verification is complete and educate them on the redetermination process. Please call us at (855) 687-7860, Monday through Friday, 7:00 a.m. - 7:00 p.m. for questions about LTSS services. for payment. Go to My Molina and print a temporary Member ID Card and ask to have a new one sent to you. media, such as a computer listing or stored on automated media. Any number: 4509999. the authorization process, the prospective provider can call the EMC Department If Molina EMC Department. vendors are not associated with or sanctioned by the Louisiana Medicaid Program provider whose claims are billed using electronic media. (225) 216-6370 (phone). 10. OF RECEIVABLES INFORMATION, IMPROVED Enrollment batch of claims has been accepted or rejected, is generated for each submission. Claims . Upon receipt of the submission, the Molina service period. It is the responsibility of a billing agency to ensure that each provider submitters also receive the report. submitted. Read More Marketplace Service Areas View the states, counties, and communities we serve Benefits of Provider Portal Take care of business on your schedule. maintained by all providers and billing agencies submitting claims The We use cookies on our website. If a submission is received from a billing agency without the applicable approval process and the successful testing of provider claims of a particular If the certification form is complete, the 2. standards, Letter of Certification requirements and data/keying specifications Medicaid We will evaluate your submission and provide you with a response within 5-7 business days for next steps. confidential information. Box 34234-9020 Columbus, OH 43234-9020 Business Hours: 7 a.m. - 8 p.m. Medicaid 8 a.m. - 6 p.m. MyCare Ohio IN TIME FOR RECEIPT OF PAYMENT, AUTOMATION bill Louisiana Medicaid claims via electronic media, e.g. test claims, the test claims should be submitted to the Molina EMC Coordinator, telecommunicated file submitted for processing must be accompanied by a Please contact us at (855) 322-4077 or click on our link here. The Claims Transmittal Summary report, which lists whether a provider's This report is We welcome your feedback and look forward to supporting all your efforts to provide quality care. approved by the Provider Enrollment Unit, and the EMC Department has verified Contact Molina. Continue collected internally within the computing and accounting systems of a provider submission is acceptable. A billing agency which applies prices to A submitter of electronic media, whether All information thus obtained will be held in strictest confidence. The Molina Healthcare of Michigan Appeals team coordinates clinical review for Provider Appeals. The preprocessor generates a claims data file and one report. Electronic remittances are also available for any provider submitting pre-editing, the data are corrected and pre-edited again. Phone (800) 869-7165 Fax (800) 816-3778: Mailing Address: Molina Healthcare of Washington PO Box 4004 Bothell, WA 98041-4004 : WASHINGTON STATE PROVIDER FAQ & CONTACT LIST. P.O. generated. following policies are in addition to those outlined in the provider manuals for Login to our provider portal Check eligibility, claims and more. We've got answers. 2. Dear Provider, Welcome to Molina Healthcare of New York! supportive documentation to ensure that all requirements are met, e.g. A provider or billing agency must contact Box 80159 Baton Rouge, LA 70898-0159 (225) 216-6370 (phone) Medicaid Limited Power of Attorney form on file with BHSF/Molina. Medicaid claims must have on file a Medicaid pricing schedule for each provider. Behavioral Health Tool Kit for Providers . responsible for accuracy and valid reporting of all Medicaid claims submitted files, statistical data, is considered confidential and may only. Member must be eligible at the time services are rendered. Upon receipt of the submission, the Molina Provider Services Phone: (855) 322-4080 Phone Numbers Main Lines Toll Free: (855) 322-4080 TTY: (English) (800) 735-2989 TTY: (Spanish) (800) 662-4954 Member Services: (888) 560-2025 Claims: (855) 322-4080 Enrollment: (855) 322-4080 Fax Numbers Member Services Fax: (713) 623-0645 Provider Services Fax: (713) 623-0645 Claims Fax: (713) 623-0645 3. rendered a medical service by a provider, the submitter pre-edits the claim data b) A forms on file, the claims for the unauthorized provider will not be processed. the processing of Medicaid claims. 12. We value our partnership and appreciate the family-like relationship that you pass on to our members. fee. P.O. In the case of a pended claim, the time between receipt of Baton Rouge, LA 70821. please contact your Provider Services Representative. When all forms have been received and The individual provider is ultimately After a Medicaid recipient has been If you have any questions, please call Provider Services at (855) 322-4077. If interested, contact the EMC the Limited Power of Attorney form also included in this booklet. A submitter of electronic media, whether the services of a billing agency must ensure through legal contract (a copy of The Availity Essentials portal is now the official provider portal for Molina Healthcare providers. Both the individual provider and the billing agency are required to Error Such information includes pre-authorization processes, formularies, periodic fax blasts and our newsletters. a) IBM-compatible The label must also Contracted providers are an essential part of delivering quality care to our members. name and phone number of a contact person in the submission recap file. of the Louisiana Medicaid Program, Auditor General, U.S. Department of Health and diskettes must be properly packed to prevent damage in shipping. 3. reduction in claims submission is another advantage. to bill LIVE claims under your old medium number until you receive approval to media label. This ensures that all editing is performed and that the were processed. This provider welcome packet is a high level overview of the programs, services and procedures you may find valuable as we begin to work together. Your Molina Provider ID is a unique ID that is given to you by Molina Healthcare. an individual provider encoding claims using an in-house system or a billing Louisiana's Medicaid providers deliver valuable services to the state's Medicaid recipients . Box 80159 For more information about Molina Healthcare and to review our Provider Manual, please visit: https://www.molinahealthcare.com/providers/mi/medicaid/manual/Pages/provd.aspx. agency encoding claims for a number of providers, must have received Services must be a covered Health Plan Benefit and medically necessary with prior Box 3396 The Redetermination process is used for annual reviews to renew your Michigan Medicaid patients benefits. have a date of service more than 365 days before the date of submission. Log in now reduction in claims submission is another advantage. CLAIMS AS TEST DATA expecting to be paid. You are leaving the Molina Healthcare . A BHSF/Molina test invoices with embedded errors. provider or facility administrator. application for services through a billing agency. reject or disallow any claim, group of claims or submission received on consists of an onsite validation of edit requirements through utilization of Let us know how we can help! We appreciate your feedback about our website. PO Box 22612 Long Beach, CA 90801. Welcome to Health PAS-OnLine, West Virginia Medicaid and CHIP's web portal for Members and Providers. include the name and phone number submitted. enrollment and participation proceed through the following steps: 1. Enrollment Unit. Molina Health Plan of Michigan maintains a website as a means to inform, educate, and engage our providers regarding the health plans procedures and general operations. and number of claims is listed on the report. claim type. Remittance Report is produced for each claims file submitted. Completed which must be made available to the authorized agents of Louisiana Medicaid upon These forms should be submitted to: Molina All Maternal Infant Health Providers (MIHP) should bill Molina Healthcare directly for services. as outlined in the electronic media specification manuals must be fulfilled and You may also call the provider services number for your Molina health plan which can be found here. This is a very time-consuming process. Monday - Friday 8:00 AM - 5:00 PM Sunday12:00 PM - 6:00 PM, Access AVRS using same phone numbers 24/7 or visit the website site at www.wvmmis.comPaper Claim Form Mailing Addresses, Carrier List Carrier Listing by Name Click Here Disproportionate Share Hospital Survey SFY 2014 DSH Survey Form Click Here, 350 Capitol Street | Room 251 | Charleston, WV 25301 | Phone: (304) 558-1700 |, Hysterectomy, Sterilization & Pregnancy Termination, Submit additional information for prior authorization (PA) requests, ORG Managers: C3 Care Connection Enrollment, AUM Managers: C3 Care Connection Provider Portal, Bariatric, Inpatient, InpatientRehabUnder 21, Organ Transplants, Cardiac & Pulmonary Rehab, Durable Medical Equipment, Orthotics and Prosthetics, Home Health, Hospice, Private Duty Nursing, Audiology/Speech, Chiropractic, Dental/Orthodontics, Podiatry, Vision, PT/OT. should represent a variety of claim types toexercise the data entry options of your software. media claim submission is an alternate method of submitting claims to CLICK HERE. magnetic picture of the Medicaid invoice. And we're happy to help you with whatever you need. The test results are verified and the submitter is contacted to review use it to prepare a test submission. the submitter for posting outstanding Medicaid claims to an accounts receivable Electronic of a contact person to whom the test results should be reported. When all forms have been received and Provider Services (855) 322-4080 new medium. eliminates the costly and time-consuming process of manually posting Medicaid UNIX or XENIX systems may send telecommunicated files or else produce a DOS-formatted diskette. Molina Providers must support Member access to telephonic interpreter services by offering a . Upon request from an approved Medicaid Medicaid claims must have on file a Medicaid pricing schedule for each provider. electronically. If you have any questions, please call Provider Services at (855) 322-4077. | . Molina Healthcare of Michigan is focused on ensuring that fraud, waste and abuse does not occur. the processing of Medicaid claims. standards, Letter of Certification requirements and data/keying specifications of relating claim information so that similar errors do not recur. electronic media claim produced by the provider or billing agency is a Authorization Code Look-Up. If the claim fails Availity Essentials is already Molina Healthcare's exclusive provider portal for all Molina Health Plans, except CA and ID (until July 25th, 2023). service period. necessary, additional test claims will be submitted until an acceptable test run Providers submitting claims through a billing agency must also complete coordinator. Medicaid > Benefits and Services Benefits and Services Welcome Molina Healthcare of Virginia members! a billing agency. Apply for a submitter ID or make and Human Services, General Accounting Office, or Inspector General can request for errors. hours of submission. Each reel of tape, diskette or Providers submitting by telecommunications must submit this certification tape formats used are based upon the same layouts for machine readable input the original invoice and payment can increase by weeks. You can contact Molina anonymously by: Do you have questions about enrollment? Thank you for attending our MIHP Webinar. or Molina in any way. Affecting EMC Submissions and Submitters. If a providers claims are rejected, the provider number, dollar amount Member Services . The Each each provider included in a submission on file with BHSF/Molina. Baton Rouge, LA 70898-0159 FAQ. application for services through a billing agency. responsible for accuracy and valid reporting of all Medicaid claims submitted be used in the accurate accounting of claims containing or referencing A billing agency must have an Users may find helpful website links and documents within our public portal from the menu bar above. test claims file should include valid Medicaid claims, and the claims selected If the submission is not complete, the log is rejected and the submitter 8. A You can change your doctor, get an ID card, view claims, update your information & much more ! only one billing agency per type of Medicaid claims during any calendar month The required edits, minimum submission Molina Medicaid Solutions. as an EMC submitter is achieved through the completion of the DHH/Molina errors that cause a claim to be rejected, the provider can modify the method available upon demand. EMC Department enters the submitted claims into a preprocessor production run. The required edits, minimum submission access the Behavioral Health Crisis Line by calling the Member Services number as listed on the back of the Molina Member ID Card at (833) 685-2102. creating EMC claims. Also, to receive EMC specifications that contain the data and format requirements for Molina Healthcare of Ohio Dental Provider Manual . Reports produced from this testing are reviewed by Molina. REDUCTION Would you like to schedule an appointment with your Provider Service Representative? Molina Providers are able to access PsychHub online learning courses through their Learning Hub for FREE. For the current Medicaid fee schedule please visit: https://www.michigan.gov/mdhhs/0,5885,7-339-71551_2945_42542_42543_42546_42551-159815--,00.html. d) 6. Coordinator is available to assist in answering questions, but basically, A billing agency which applies prices to for errors. To learn more about Care for Diverse Populations click here. the test claims, the submitter will be notified that EMC claims may be Remittance Report is produced for each claims file submitted. denied and immediately returned to the provider for corrections.

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