Molina Healthcare billing and credentialing
Billing and credentialing for Molina Medicaid, Marketplace and Medicare plans.
Working with Molina Healthcare
Molina Healthcare focuses on government-sponsored care: Medicaid managed care, dual-eligible Medicare plans and Marketplace plans in many states.
Plan types we bill:
- Medicaid managed care
- Medicare and dual-eligible plans
- Marketplace plans
Credentialing and enrollment
For Medicaid products, you must first be enrolled with the state Medicaid agency, then credentialed with the plan.
Credentialing uses your CAQH ProView profile, which must be complete and re-attested every 120 days.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Molina uses Availity Essentials for eligibility, claims and authorizations in most states. Prior authorization lists differ by state and product.
Denials we prevent with Molina Healthcare
- Provider enrolled with the state but not credentialed with the plan
- Member assigned to a different plan this month
- Missing plan prior authorization
- Behavioral health or vision carved out to another vendor
- State-specific coding or modifier rules not followed
Questions about Molina Healthcare
Do Molina rules differ by state?
Yes. Authorization lists, fee schedules and some coding rules depend on the state contract.
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with Molina Healthcare claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.