Alert!

There is a global technical issue impacting many companies like pharmacies and transportation. Molina’s systems including Availity provider portal are also impacted.

Thank you for your patience while we work to fix the issues. For urgent access to care issues please call Provider Services..

Welcome Molina Medicare Providers!

It is important to Molina Healthcare and your patients that your provider directory demographics are accurate. Please visit our Provider Online Directory at: https://molina.sapphirethreesixtyfive.com/ to validate your information and notify us if there are any updates.

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
  • Addition or termination of a provider
  • Change in Tax ID and/or NPI
  • Open or close your practice to new patients (PCPs only)

Changes for 2025:

Medicare 2025 expansion includes:

  • Plan Expansions:
    • SNP: (4) new plan offerings in Mississippi, Nebraska, and New Mexico
  • Service Area Expansions: New counties in (7) existing Molina states and (3) new states
    • Existing Molina States: Idaho, Kentucky, Nevada, Ohio, South Carolina, Texas, and Utah
    • New States: Mississippi, Nebraska, and New Mexico
  • Plan Non-Renewals: Arizona Molina Medicare Choice Care (HMO), California Molina Medicare Choice Care Select (HMO), Idaho Molina Medicare Choice Care (HMO), Illinois Molina Medicare Choice Care (HMO), Kentucky Passport Medicare Choice Care (HMO) , Massachusetts Senior Whole Health Medicare Choice Care (HMO) and Senior Whole Health Medicare Choice Care Select (HMO), Michigan Molina Medicare Choice Care (HMO) and Molina Medicare Choice Care Select (HMO), Nevada Molina Medicare Choice Care (HMO), Ohio Molina Medicare Choice Care (HMO), Molina Medicare Complete Care Select (HMO D-SNP), and Molina Medicare Choice Care Select (HMO), South Carolina Molina Medicare Choice Care (HMO), Texas Molina Medicare Choice Care (HMO) and Molina Medicare Choice Care Select (HMO), Utah Molina Medicare Choice Care (HMO), Virginia Molina Medicare Choice Care (HMO), Washington (Molina Medicare Choice Care (HMO), and Wisconsin (Molina Medicare Choice Care (HMO) and Molina Medicare Complete Care Select (HMO D-SNP)

Provider Manuals

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Forms

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EDI/ERA/EFT

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Prior Authorization Forms

Medical, BH, Pharmacy

2025 Medicare PA Guide
2025 Medicare PA Form
2025 Medicare BH PA Form
2025 Medicare Pharmacy PA Form

2024 PA Code Matrices & Forms

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2023 PA Code Matrices & Forms
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Archive PA Code Matrices & Forms

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PA Criteria

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Guidelines

Clinical Practice Guidelines
Provider Portal User Guide
MCG Cite AutoAuth Provider Access Quick Resource Guide

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Model of Care

Model of Care Provider Training Quick Reference Guide
2024 Model of Care Provider Training 

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2025 Model of Care Provider Training

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Health Resources

Behavioral Health Toolkit
Culturally and Linguistically Appropriate Resources
Medical Record Standards
Quality Improvement
Home Care FAQ

HEDIS/CAHPS

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Formulary

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Policies

Member Rights & Responsibilities
Provider Rights & Responsibilities
Advance Directives
Credentialing Rights
Fraud Prevention
Patient Safety
In Office Laboratory Tests

Payment Integrity Policies

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Communications

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Rx Forms

How to Request a Redetermination

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Redetermination Form

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Direct Member Reimbursement Form

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Medicare Compliance Program

The Molina Compliance Hotline:
Ph: 866-606-3889

To report an issue online visit: https://molinahealthcare.AlertLine.com

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Medicare Compliance Training

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