Important provider resources and policies

For all your Non-Emergent Medical Transportation (NEMT) needs, please contact MTM at (800) 424-4518 for Cardinal Care Managed Care members.

Molina encourages electronic payment of your claims remittance. In order to get your claims payment direct deposited into your bank account, please complete and return this enrollment form, along with all requested documentation within the form. Return the documentation to MCCVA-Provider@MolinaHealthcare.com.

  • Providers responsibilities

    Molina Network provider participation

    Molina Healthcare is dedicated to selecting healthcare professionals, groups, agencies and facilities to provide member care and treatment across a range of covered services as defined by Virginia Department of Medical Assistance Services (DMAS).

    To be a network provider of health care services with Molina under the Cardinal Care Managed Care program, you must be credentialed and contracted according to Molina and DMAS standards. Providers are subject to applicable licensing requirements. You have the right to request the status of your credentialing or recredentialing application.

    Your responsibilities

    Your responsibility, as an Molina network provider of health care services, is to:

    • Provide medically necessary covered services to members whose care is managed by Molina and comply with all applicable non-discrimination requirements
    • Maintain eligibility to participate in Medicare/Medicaid or other federal or state health programs. You may not be excluded from participation while under agreement with Molina 
    • Comply with all terms of your Participating Agreement. In the event there is a conflict between the terms of your Agreement and the terms of the Cardinal Care Managed Care contract, the DMAS contract will apply
    • Review information submitted to support your credentialing application and correct any errors
    • Follow the policies and procedures outlined in the Molina provider manual, any applicable supplements and your provider participation agreement(s) as well as DMAS policies and regulations
    • Provide services in accordance with applicable Commonwealth of Virginia and federal laws and licensing and certification bodies. Contracted providers for the Cardinal Care Managed Care network are required to abide by DMAS regulations and manuals, and maintain active licensure for their contracted provider type and specialty at each service location
    • Provide covered services to Molina members as outlined in the Molina provider manual and applicable supplements and your provider agreement(s), as well as DMAS policies and regulations without exclusion or restriction on the basis of religious or moral objections
    • Agree to cooperate and participate with all system of care coordination, quality improvement, outcomes measurement, peer review, and appeal and grievance procedures
    • Make sure only providers currently credentialed with Molina render services to Molina members
    • Follow Molina's credentialing and re-credentialing policies and procedures
    • Participate and collaborate in value-based payment programs and strategies (as agreed upon in your Participating Provider Agreement) that contribute and align with Molina and DMAS care goals and outcomes for members
     

    Molina's responsibilities are to:

    • Assist with your administrative questions during normal business hours, Monday through Friday
    • Not prohibit, or otherwise restrict healthcare providers acting within the lawful scope of practice, from advising or advocating on behalf of the member who is the provider’s patient, for the member’s health status, medical care, or treatment options, including any alternative treatments that may be self-administered, any information the member may need in order to decide among all relevant treatment options, the risks, benefits, and consequences of treatment or non-treatment. And not prohibit nor restrict the member’s right to participate in decisions regarding his or her healthcare, including the right to refuse treatment, and to express preferences about future treatment decisions
    • Ensure health equity in the coverage and provision of services. This includes parity in process and coverage policy between covered medical and behavioral health service needs
    • Ensure members’ access to Native American and/or other Indian Health Services (IHS) providers, where available
    • Assist providers in understanding and adhering to our policies and procedures, the payer’s applicable policies and procedures, and other requirements including but not limited to those of the National Committee for Quality Assurance (NCQA)
    • Maintain a credentialing and recredentialing process to evaluate and select network providers that does not discriminate based on a member’s benefit plan coverage, race, color, creed, religion, sex, marital status, age, national origin, ancestry, citizenship, physical disability or other status protected by applicable law