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:

   

  Vision Providers

  Please contact our vision vendor, March Vision, for participation at (844) 636-2724 or by visiting MarchVision.com.

  Pharmacy Providers

  Please contact our Pharmacy benefits manager, CVS Pharmacy, by visiting CVS website here: Join CVS Caremark Network.

  All Other Providers

  Please complete a Contract Request Form and submit to NMProviderContracting@MolinaHealthcare.com.

   

   

• Step Two - Documentation

  If your Contract Request Form is accepted, our Provider Contracting department will provide you with credentialing and contracting documents that must be completed. Documents you receive may differ depending on provider type, and may include:

  • - Provider Agreement
  • - Provider Information Form
  • - Ownership and Control Disclosure Form
  • - W-9
  • - Practitioner Application (if practitioner does not have an updated and attested CAQH profile); and/or

  • - Health Delivery Organization Credentialing Application

  
  

  Upon receipt of completed documents, Provider Contracting will then begin the credentialing process.

• Step Three - Credentialing

  Provider Contracting will work with Molina’s Credentialing department to credential the facilities and/or practitioners included in your completed documents. The credentialing process may take up to 90 calendar days to complete. Once credentialing is completed, you will receive a notification from Molina’s Credentialing department.
  

  
  

  Note: You can help the credentialing process run smoothly, and perhaps even reduce the time it takes to credential, by making sure that you:

  - Practitioners - Complete the Practitioners Credentialing Information Form and ensure your CAQH information is up to date

  - Healthcare Delivery Organizations (HDO) – Complete the HDO Credentialing Form and provide items listed on the instructions sheet; and

  - Properly complete and sign the Ownership and Control Disclosure Form

   

• Step Four - Contract

  The final step will be for Molina to countersign your Provider Agreement and provide you with a signed copy. Credentialed facilities and/or practitioners will also 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 the date of credentialing completion, which will be included in the notification that you will receive from Molina’s Credentialing department (referenced above in Step 3 – Credential).

• Step Five - Important Reminder

  It is important to Molina Healthcare and your patients that your provider directory demographics are accurate. The State of New Mexico Department of Health and Human Services assigns a Provider Medicaid ID number to each Provider address. The Provider Medicaid ID number/address/NPI combination along with the Group NPI and Tax ID on file with Molina, must match the information that is on file with the New Mexico Medicaid Provider Portal for claim payment; therefore, all changes should be made through the New Mexico Provider Portal at New Mexico Provider Enrollment Update Form.

Discrepancies in information can impact claims payment and result in claim rejection
To prevent issues, please follow these steps:

1. Visit our Need URL for online Provider Directory to validate your information with Molina is the same as your information on file with NM Provider Portal.
2. Corrections, add/changes to Group affiliations or locations, or updates to Tax ID, etc. must be completed on the NM Provider Portal and will be sent to Molina. Please visit the NM Human Services Dep Provider Data website to make changes. 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)

 

Questions?

If you have any questions or concerns, email our Provider Contracting department at NMProviderContracting@MolinaHealthcare.com or call our Provider Contact Center at: (855) 322-4078.