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* When Prior Authorization is 'Required', click here to create Service Request/Authorization
PA Lookup tool is under maintenance.
Please refer to the state specific Excel matrix while the PA Lookup Tool is disabled.
Recent Updates
Effective Feb. 1, 2023, Provider Services will no longer accept claim disputes via email. All claim disputes for a denial, payment amount, or code edit must be submitted following the Provider Claim Dispute Process. More information can be located in the January Provider Bulletin here.
As of March 28, 2023, providers will no longer have direct access to the Molina Legacy Provider Portal. We encourage you to register with Availity here.
Molina posted the Ohio Medicaid-specific clinical policies on our Medicaid Provider Website here.
The Medicaid Provider Manual, effective as of Feb. 1, 2023, is posted here.
The MyCare Ohio Provider Manual, effective as of Feb. 1, 2023, is posted here.
The current PA Code List became effective Jan. 16, 2023. View it here.
Next Generation Medicaid Information:
Do You Have Your OH|ID? As of Oct. 1, 2022, all Medicaid providers need an OH|ID. Providers must obtain an OH|ID to access the PNM or Single Pharmacy Benefit Manger (SPBM) web portal and do business with Ohio Medicaid. Get your OH|ID today here.
Based on guidance from the Ohio Department of Medicaid (ODM) for the Next Generation Medicaid, Molina will begin denying claims submitted by non-enrolled or inactive providers on Feb. 1, 2023. Learn more here.
Credentialing Reminder: As of Oct. 1, 2022, ODM will be the single point of contact for provider credentialing for Medicaid and MyCare Ohio via the new Provider Network Management (PNM) module. Molina will be responsible for provider recredentialing until Jan. 31, 2023. Find out more in the October 2022 Provider Bulletin, posted here.
PNM Training: ODM PNM provider resources (no log in required) are available here or visit the ODM website to register for a self-paced training session or sign up for virtual and/or in-person learning here.
SPBM Training: Visit the Gainwell website to view Pharmacy Web Portal training or Prescriber Web Portal training. Find the Gainwell website here.
ODM Press: Read the ODM Press here to stay updated on upcoming Next Generation Medicaid changes and visit the ODM Next Generation Medicaid Providers page here. Subscribe to the ODM Press here. For questions about the Next Generation program, contact ODMNextGen@medicaid.ohio.gov.
Medication Assisted Treatment
Addiction
Basics
Safety
Molina Peer Support Program
Addiction
For more information call (855) 665-4623, TTY/TDD: 711, Monday - Friday from 8:00 a.m. - 8:00 p.m. local time and ask for our Care Management department.
Medicare Compliance Program
Molina Compliance Hotline: (866) 606-3889 or Molinahealthcare.AlertLine.com
Reporting Compliance and Fraud, Waste, or Abuse
Molina Medicare Compliance Program
Code of Business Conduct and Ethics
Medicare Compliance Issues Policy
Document Retention and Destruction Policy
Medicare Fraud, Waste, and Abuse Plan
FDR Compliance Auditing Policy
Your Opinion Matters to Molina
Email us to share your comments, concerns or ideas. Your feedback is important to us. Let us know what we're doing well and what we can do to improve.
Molina Healthcare of Ohio's "It Matters to Molina" program prioritizes connecting directly with our network of over 90,000 providers and supporting their efforts to deliver high-quality and efficient health care for Molina members.
Through the “It Matters to Molina” program, we have a dedicated Provider Services Team to intake and resolve your questions or issues and solicit input and feedback from you, our network providers and administrative staff, about ways Molina can improve our technology, tools and processes to minimize administrative hurdles and better support you.