Provider Bulletins
- Participating Provider Attestations
- Optum-Change Healthcare Outage
- Community Laboratory Fee Schedule Effective January 1, 2023
- New York State Benefit Changes Effective 1/1/2023 for Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), Essential Plan (EP), and Child Health Plus (CHP) Products
- Molina Availity Essentials Provider Portal
- Access and Availability Reminder
- Pharmacy Benefits Transitioning from Medicaid Managed Care Plan to NYRx, the Medicaid Pharmacy Program
- Provider Annual Attestations
- Help Your Patients Keep Their Health Insurance
- Required Cultural Competency Training for Participating Provider
- GoMo Health Assists in Outreach with Patients with Gaps in Care
- Required Cultural Competency Training for Participating Provider
- Changes to Prior Authorization Requirements
- Q4 Molina Initiative: Cologuard Outreach
- DME 2024 Fee Schedule Reminder
- Molina Q3 2024 PCMH Payments
- Provider Annual Attestations
- Annual Required Cultural Competency Training Reminder for Participating Providers
- Molina Provider Town Hall Webinar
- Molina Provider Webinar Registration
- Access and Availability Reminders
- Annual Cultural Competency Training and Attestation
- Quarterly Roster and Data Request
- Quarterly Roster and Data Request
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 3/29/2024
SUBJECT: Participating Provider Attestations
ATTESTATION FORMS DUE MAY 1
Each year, Medicaid managed care providers are required to complete three brief attestation forms – DO, Employee, HIV forms. These forms are a NYS Medicaid Requirement. Below is a brief description of what each form will confirm. The forms are available through the Monroe Plan Provider Portal or our Monroe Plan website. If you have not already registered for the Monroe Plan Provider Portal, you can access the portal by clicking here: Monroe Plan Provider Portal or by visiting our website: Provider Resources & Forms – Monroe Plan for Medical Care. All forms should be sent to providerrelations@monroeplan.com.
If you have standard version of these forms already completed, you can submit those completed forms to providerrelations@monroeplan.com and that will satisfy this requirement.
Below is a list of attestation forms needed and a brief description of each form.
- Provider Employee Attestation Form: Use this form to certify that all employees and other provider personnel are not excluded or otherwise prohibited from participating in any state or federal healthcare program. This form needs to be attested and sent to Monroe Plan yearly.
- HIV Attestation Form: Use this form when attesting that you agree that you are an accredited HIV Provider. This form needs to be attested and sent to Monroe Plan yearly. If you are not an accredited HIV Provider, then this form can be left out of the annual attestation packet.
- Ownership Disclosure Form: Use this form to attest disclosure of ownership and financial interest of the group or facility. This form needs to be attested and sent to Monroe Plan yearly.
Thank you for all you do for our members and our communities at large.
Provider Relations & Network Management
February 26, 2024
Optum-Change Healthcare Outage
Molina Healthcare, Inc. is advising our providers of a critical outage of our third-party vendor, Optum-Change Healthcare (CHC), resulting in impacts to: Electronic Claims Submission, Payment, and Settlement Services.
Claims Submission
Providers utilizing CHC to submit claims to Molina prior to this outage, may now do so via our alternate established connection with SSI Claimsnet, LLC (“SSI Group”) clearinghouse or another clearinghouse of their choice. Providers not directly utilizing CHC can and should continue utilizing their current clearinghouse for claims submission. Our Availity Essentials Provider portal solution was not impacted by this outage and remains available as another option to key-in claims for claims submission.
Providers can register with SSI Group for claim submission via the Claimsnet’s Provider Registration Form located online at: https://products3.ssigroup.com/ProviderRegistration/register
Providers can register with Availity Essentials to key-in claims for submission at:
https://www.availity.com/molinahealthcare
During this transition we encourage all our providers submitting paper claims to explore our electronic submission options.
For those providers who have submitted electronic claims to Molina via a clearinghouse on, or after 2/21/2024, and have not received acknowledgement from Molina of receipt, we advise resubmitting those claims as soon as possible. This statement does not apply to any providers submitting directly to SSI Group, UHIN, TMHP, COBA, or via our Availity portal solution.
Provider Payment
Provider payment through CHC is currently unavailable and we are actively working on an alternate payment solution. Additional information will be available soon.
We understand that this outage can disrupt you and your place of practice. Molina is in regular contact with CHC and our key partners to help mitigate this outage. We will be in continued communication with our provider community regarding this situation. We appreciate your patience and understanding during this unprecedented time of disruption. Thank you for your continued partnership.
Questions?
All questions should be directed to Molina’s provider contact center at 877-872-4716 or your local provider services representative.
Monroe-Plan-YourCare-IPA-Laboratory_Fee_Schedule-Effective-Jan-01-2023
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: December 1, 2022
SUBJECT: New York State Benefit Changes Effective 1/1/2023 for Medicaid Managed Care (MMC), Health and Recovery Plan (HARP), Essential Plan (EP), and Child Health Plus (CHP) Products
In accordance with New York State requirements, this notice is to provide updated member benefit information effective January 1, 2023, regarding the products referenced above as administered by Molina Healthcare of New York Inc.
Please note that some benefits may have limitations and if there are questions as to whether a service is covered or requires Prior Authorization, please reference the Prior Authorization tools located on the Molina website.
For additional information and a chart summary of the specific added benefits and services, please refer to the
attachment to this notice as well as visiting Molina’s website link below at:
https://www.molinahealthcare.com/providers/ny/medicaid/comm/bulletin.aspx
This notice and the updated grid will also be posted to the Monroe Plan website at (www.monroeplan.com) under the IPA and Provider Services tab.
As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.
Thank you for all you do for our members and our communities at large.
Click here to review benefit changes.
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: February 8, 2023
SUBJECT: Molina Availity Essentials Provider Portal
Beginning March 28, 2023, Availity Essentials will be the official secure provider portal for Molina Healthcare providers. Molina’s legacy portal will no longer be available for direct transactions. Please register on Availity to ensure that you have uninterrupted access to all your portal information, tools, and functions.
To register visit: https://www.availity.com/molinahealthcare
This notice and the updated grid will also be posted to the Monroe Plan website at (www.monroeplan.com) under the IPA and Provider Services tab.
As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.
Thank you for all you do for our members and our communities at large.
Provider Bulletin
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: March 1, 2023
SUBJECT: Access and Availability Standards
In accordance with New York State requirements, this notice is to serve as a reminder that New York State routinely completes surveillance activities to evaluate compliance with the following appointment availability standards, (Medicaid Model Contract 15.2, Appointment Availability Standards). By following the appointment availability standards established by the New York State Department of Health we can improve patient access to routine, urgent, preventive and specialty care. We also follow 24-hour access standards to measure after-hours access.
These standards apply to all lines of business, to learn more view our tip sheet: Access-and-Availability-Standards_MPwebsite_TIPS_2022.pdf (monroeplan.com)
This notice and the tip sheet will also be posted to the Monroe Plan website at (www.monroeplan.com) under the IPA and Provider Services tab.
As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.
Thank you for all you do for our members and our communities at large.
PROVIDER BULLETIN
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 03/23/2023
SUBJECT: Pharmacy Benefits Transitioning from Medicaid Managed Care Plan to NYRx, the Medicaid Pharmacy Program
Effective April 1, 2023, New York State Medicaid members enrolled in mainstream Medicaid Managed Care (MMC) Plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plans (SNPs) will have their pharmacy benefits transitioned from their Medicaid Managed Care Plan to NYRx, the Medicaid Pharmacy Program. Click the link below for information regarding the Pharmacy Benefit Transition in the October 2022 Special Edition Medicaid Update New York State Medicaid Update:October 2022 NYRx Pharmacy Benefit Transition.
Questions and Additional Information:
Guidance for Providers NOT Enrolled in Medicaid:
- Providers may check their enrollment status by reviewing the Medicaid Pended Provider Listing found here: Provider Verification
- Prescribers that are not enrolled in the Fee-For-Service program must enroll, to continue serving Medicaid Managed Care members. Instructions for checking enrollment status and enrollment tips can be found on the eMedNY Provider Enrollment
- Questions regarding the enrollment process, your enrollment status, or what you need to do to enroll, please contact providerenrollment@health.ny.gov or call the eMedNY Call Center at 1-800-343-9000
- Enrollment policy questions should be directed to the Medicaid Pharmacy Policy
Unit by telephone at (518) 486-3209 or by email at NYRx@health.ny.gov.
Guidance for Navigating the New NYRx Pharmacy Program:
- NY Medicaid Pharmacy Program Information for Prescribers: Prior Authorization Information
- NYS NYRx Quick Reference Guide: NYS NYRx FAQ
- Member Fact Sheet: What Members Need to Know Handout
As always, please do not hesitate to contact us directly at our general Provider Relations e-mail address providerrelations@monroeplan.com with any questions pertaining to this information.
Thank you for all you do for our members and our communities at large.
Provider Relations & Network Management
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 04/03/2023
SUBJECT: Provider Annual Attestations
ATTESTATION FORMS DUE MAY 1
Each year, Medicaid managed care providers are required to complete three brief attestation forms – DO, Employee, HIV forms. These forms are a NYS Medicaid Requirement. Below is a brief description of what each form will confirm. The forms are available through the Monroe Plan Provider Portal or our Monroe Plan website. If you have not already registered for the Monroe Plan Provider Portal, you can access the portal by clicking here: Monroe Plan Provider Portal or by visiting our website: Provider Resources & Forms – Monroe Plan for Medical Care. All forms should be sent to providerrelations@monroeplan.com.
If you have standard version of these forms already completed, you can submit those completed forms to providerrelations@monroeplan.com and that will satisfy this requirement.
Below is a list of attestation forms needed and a brief description of each form.
- Provider Employee Attestation Form: Use this form to certify that all employees and other provider personnel are not excluded or otherwise prohibited from participating in any state or federal healthcare program. This form needs to be attested and sent to Monroe Plan yearly.
- HIV Attestation Form: Use this form when attesting that you agree that you are an accredited HIV Provider. This form needs to be attested and sent to Monroe Plan yearly. If you are not an accredited HIV Provider, then this form can be left out of the annual attestation packet.
- Ownership Disclosure Form: Use this form to attest disclosure of ownership and financial interest of the group or facility. This form needs to be attested and sent to Monroe Plan yearly.
Thank you for all you do for our members and our communities at large.
Provider Relations & Network Management
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: May 8, 2023
SUBJECT: Provider Can Help Patients Stay Covered
Help Your Patients Keep Their Health Insurance
Medicaid, Essential Plan, Child Health Plus Benefits
Some of your patients could lose their NY State of Health Medicaid Managed Care, Child Health Plus or Essential Plan benefits if they do not complete their recertification paperwork on time. Unfortunately, your patients may not be familiar with the recertification process or how it applies to them.
We are asking for your help to boost awareness if you provide care and services to Molina members in the following plans: Molina Health Care of New York Medicaid Managed Care (MMC) Health Plan, Molina Healthcare PLUS Health Plan, Child Health Plus (CHPlus) Health Plan, or Essential Plan
Providers can play an important role in helping to keep their patients’ coverage without interruption. Please check your patients’ renewal (recert) date by going to the Molina Provider Portal (if you have not registered for the Molina provider portal, please visit this link: Molina Provider Portal and accessing the patient and eligibility details. You can also remind your patients that they will need to keep their health insurance to avoid any gaps in coverage. For more information visit: Renew My Coverage | Molina Healthcare of New York)
If members need more information they can call: Molina Healthcare at (844) 239-4911Y:711).
Thank you for all you do for our members and our communities at large.
Provider Relations & Network Management
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 6/7/2023
SUBJECT: Required Cultural Competency Training for Participating Provider
Required Cultural Competency Training for Participating Providers
The New York State Department of Health (DOH) has approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training. The training is online, free, and offers several provider specific programs that can offer up to nine hours of CME credit hours. This program can be accessed at the following link: Education – Think Cultural Health (hhs.gov).
New York State previously approved cultural competency training for behavioral health providers (see: https://omh.ny.cultural_competency_curriculum.pdf ). Therefore, behavioral health providers, may utilize either the Think Cultural Health or the approved BH training to meet this requirement.
Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the completed certificate to providerrelations@monroeplan.com be sure to complete this required Cultural Competency Training on or before October 1, 2023, and then annually thereafter.
Thank you for all you do for the community at large,
Provider Relations & Network Management
TO: Participating Monroe Plan IPA and YourCare IPA Network Primary Care Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: June 22, 2023
SUBJECT: GoMo Health Assists in Outreach with Patients with Gaps in Care
As the healthcare landscape continues to change, so too has the approach to patient care. Beginning April 2023 Monroe Plan for Medical Care rolled out a personalized text messaging campaign on behalf of our providers using GoMo Health to patients with select Gaps in Care.
This targeted approach to patient engagement, using an easy-to-use platform, has proven successful in the past. Through text, your patients are encouraged to connect with you to make appointments, escalate barriers to our care navigators for assistance, and participate in the creation of a plan of care that increases their health management skills.
Breast Cancer Screening Behavioral Health Follow Up
Cervical Cancer Screening Well Child Visits
Colorectal Cancer Screening Diabetes Testing
You may receive communication from Monroe Plan staff regarding appointments for patients OR you may receive calls from patients stating they’ve received a text message and need to schedule an appointment.
We welcome your feedback! Please reach out to Quality@monroeplan.com with any questions or comments.
Finally, if you desire to not have your Moline Healthcare assigned patients receive these texts, please complete the attached Opt-Out Form and e-mail or fax to the contact information listed.
Thank you for all you do for the community at large,
Provider Relations & Network Management
Participating Monroe Plan IPA and YourCare IPA Network Primary Care Providers
OPT-OUT OF IPA GAPS-in-CARE TEXTING PROGRAM to ASSIGNED PATIENTS
Practice Name:
Practice Tax ID #:
Authorized Signature:
Name and Title:
Date:
E-Mail to: pfmemails@monroeplan.com
or
Fax Number: 716-748-6987
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 9/15/2023
SUBJECT: Required Cultural Competency Training for Participating Provider
Required Cultural Competency Training for Participating Providers
The New York State Department of Health (DOH) has approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training. The training is online, free, and offers several provider specific programs that can offer up to nine hours of CME credit hours. This program can be accessed at the following link: Education – Think Cultural Health (hhs.gov).
New York State previously approved cultural competency training for behavioral health providers (see: https://omh.ny.cultural_competency_curriculum.pdf ). Therefore, behavioral health providers, may utilize either the Think Cultural Health or the approved BH training to meet this requirement.
Once the cultural competency training has been completed, providers need to verify completion of the program by emailing the completed certificate to providerrelations@monroeplan.com be sure to complete this required Cultural Competency Training on or before October 1, 2023, and then annually thereafter.
Thank you for all you do for the community at large,
Provider Relations & Network Management
Monroe Plan HealthCare Services
Provider Bulletin
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 5/17/2024
SUBJECT: Changes to Prior Authorization Requirements
Changes to Prior Authorization Requirements |
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PROVIDER BULLETIN
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 9/9/2024
SUBJECT: Q4 Molina Initiative: Cologuard Outreach
Q4 Molina Initiative: Cologuard Outreach
Molina Healthcare of NY has contracted with Exact Sciences for a Cologuard initiative to target those with an open gap for colon cancer screening. Molina will apply exclusionary criteria/diagnoses before outreaching to members and offering the Cologuard testing.
If you have any questions, please email pfmemails@monroeplan.com for additional details.
As always, thank you for all you do for our community at large.
Provider Network Management
PROVIDER BULLETIN
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: September 30th, 2024
SUBJECT: DME 2024 Fee Schedule Reminder
Dear Provider,
This is a reminder that, as of January 1, 2024, Monroe Plan IPA had announced and published the processing and payment methodologies for Durable Medical Equipment (DME) rates. DME rates will be paid at 100% of the prevailing New York Medicaid Durable Equipment Fee Schedule.
If, you have questions, please send an email to providerrelations@monroeplan.com.
Thank you for all you do for the community at large,
Provider Relations & Network Management
PROVIDER BULLETIN
TO: Participating Primary Care Monroe Plan IPA and YourCare Primary Care IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 10/1/2024
SUBJECT: Molina Q3 2024 PCMH Payments
This Provider communication is to inform you of the changes regarding Molina PCMH payments.
Previously, Molina Healthcare was paying PCMH to all providers/locations regardless of certification.
Starting with Q3 2024 PCMH payments, Molina will ONLY be paying PCMH for those providers/locations that are certified. Once certification has been completed all certifications will be processed prospectively.
If updates need to be made, or if you need more guidance on how to register or obtain certification visit Get Started – PCMH – NCQA or call NCQA Customer Support at (888) 275-7585 for more information.
As always, thank you for all you do for our community at large.
Monroe Plan Provider Network Management
PROVIDER BULLETIN
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 03/3/2025
SUBJECT: Provider Annual Attestations
ATTESTATION FORMS DUE MAY 1
Each year, Medicaid managed care providers are required to complete three brief attestation forms – DO, Employee, HIV forms. These forms are a NYS Medicaid Requirement. Below is a brief description of what each form will confirm. The forms are available through the Monroe Plan Provider Portal or our Monroe Plan website. If you have not already registered for the Monroe Plan Provider Portal, you can access the portal by clicking here: visiting our website: Provider Resources & Forms – Monroe Plan for Medical Care. All forms should be sent to providerrelations@monroeplan.com.
If you have standard version of these forms already completed, you can submit those completed forms to providerrelations@monroeplan.com and that will satisfy this requirement.
Below is a list of attestation forms needed and a brief description of each form.
- Provider Employee Attestation Form: Use this form to certify that all employees and other provider personnel are not excluded or otherwise prohibited from participating in any state or federal healthcare program. This form needs to be attested and sent to Monroe Plan yearly.
- HIV Attestation Form: Use this form when attesting that you agree that you are an accredited HIV Provider. This form needs to be attested and sent to Monroe Plan yearly. If you are not an accredited HIV Provider, then this form can be left out of the annual attestation packet.
- Ownership Disclosure Form: Use this form to attest disclosure of ownership and financial interest of the group or facility. This form needs to be attested and sent to Monroe Plan yearly.
Thank you for all you do for our members and our communities at large.
Provider Relations & Network Management
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 04/7/2025
SUBJECT: Annual Required Cultural Competency Training Reminder for Participating Providers
Communicating Across Cultures
The Mainstream Medicaid Managed Care, HIV Special Needs Plans, and Health and Recovery Plans Model Contract Section 15.10(c) mandates that the MMCP ensure the cultural competence of its provider network. Participating Providers are required to certify, on an annual basis, completion of State-approved cultural competence training curriculum, including training on the use of interpreters, for all staff who have regular and substantial contact with Enrollees.
Providers have options to complete the required annual competency training. Presented below are two available options for completing this training:
A. The New York State Department of Health (DOH) has approved training offered by the United States Department of Health and Human Services (HHS), Office of Minority Health education program, Think Cultural Health, to fulfill the requirement for provider annual cultural competency training. The training is online, free, and offers several provider specific programs accessible at the following link: Education – Think Cultural Health (hhs.gov).
New York State previously approved cultural competency training for behavioral health providers (see: https://omh.ny.gov/omhweb/bho/docs/cultural_competency_curriculum.pdf ). Therefore, behavioral health providers, may utilize either the Think Cultural Health or the approved BH training to meet this requirement.
B. Clear communication is essential for providing culturally and linguistically competent care. For more information, please visit: Molina Training on Culturally and Linguistically Appropriate Resources / Disability Resources.
Upon completing the annual cultural competency training, kindly forward the signed attestation form to providerrelations@monroeplan.com
Please ensure that you complete this required Cultural Competency Training on or before October 1st, 2025, and annually thereafter.
Thank you for your continued dedication to the community at large.
Provider Relations & Network Management
PROVIDER BULLETIN
TO: Participating Monroe Plan IPA and YourCare IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: April 24, 2025
SUBJECT: Molina Provider Town Hall Webinar
Provider Town Hall Webinar – April 30, 2025
Molina Healthcare will conduct a live webinar training for providers. This session, presented by Molina’s Provider Relations team, will offer an overview of essential topics related to being a Molina provider.
Date & Registration: Providers are invited to register for the training using the following link:
Welcome to Molina Provider Training Webinar
Topics Covered:
- Introduction to Molina Healthcare
- Provider responsibilities
- Eligibility & ID cards
- Claim submission
- Availity portal
- Compliance guidelines
- New MMC benefits effective 4/1/25
- Provider appeals & disputes process
- Health care services
- Payment integrity & cost recovery
- Pharmacy services
- Quality improvement initiatives
- Sales, marketing & community engagement
- Provider resources
This webinar will provide valuable insights into Molina’s processes and policies:
Thank you for your continued dedication to the community at large.
Provider Relations & Network Management
TO: Participating Primary Care Monroe Plan IPA and YourCare Primary Care IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: July 14, 2025
SUBJECT: Molina Provider Webinar Registration
Stay connected with Molina Healthcare of New York through Molina’s upcoming provider webinars. Each session covers key updates and offers time for Q&A.
Upcoming Session July 30th – 9 a.m. to 10 a.m. ET
Welcome to Molina – Claims and Billing Webinar
Covered Topics:
- Provider Responsibilities
- Availity Essentials Portal
- Types of Claim Forms
- Claim Submission
- Corrected Claims
- Claim Reconsideration (Inquiry)
- Coordination of Benefits (COB)
- Code Editing
- Provider Resources
To register visit this link: Molina – Claims and Billing Webinar
We hope to see you there and as always, thank you for all you do for our community at large.
Monroe Plan Provider Network Management
TO: Participating Primary Care Monroe Plan IPA and YourCare Primary Care IPA Network Provider
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: August 27th, 2025
SUBJECT: Access and Availability Reminders
Access to Care
Monroe Plan and Molina Healthcare of New York adhere to appointment availability standards established by the New York State Department of Health. These guidelines apply across all lines of business and are designed to enhance patient access to routine, urgent, preventive, and specialty care. The established standards, along with procedures for ongoing evaluation, pertain to access in both physical and behavioral health services, as delivered by contracted primary care providers (serving both adults and children) as well as participating specialists, including OB/Gyn and behavioral health providers. Providers are required to comply with the Access to Care appointment standards outlined below to ensure timely delivery of healthcare services. Specifically, these standards stipulate 100% availability for Emergency Services and a minimum of 75% availability for all other service categories. Furthermore, primary care providers or their authorized representatives must remain accessible to members 24 hours a day, seven days a week.
Appointment Access
All Providers who oversee the Member’s health care are responsible for providing the following appointments to Molina Members in the time frames noted: * Please note that these appointment types and standards were recently updated by the New York Department of Department of Health.
|
Medical Appointment Types |
Standard |
|
Routine, asymptomatic |
Within 28 calendar days |
|
Routine, symptomatic |
Within 2-3 calendar days |
|
Urgent Care |
Within 24 hours |
|
After Hours Care |
24 hours/day; 7 day/week availability |
|
Specialty Care (High Volume) |
Within 28 – 42 calendar days |
|
Specialty Care (High Impact) |
Within 28 – 42 calendar days |
|
Urgent Specialty Care |
Within 24 hours |
|
Obstetrical Care |
Within 21 calendar days in the first trimester, within 14 calendar days in the second trimester and within 7 days thereafter.
|
|
Behavioral Health Appointment Types |
Standard |
|
Initial appointment with a healthcare professional. |
10 Business days |
|
Initial appointment with an outpatient facility or clinic. |
10 Business days |
|
Life Threatening Emergency |
Immediately |
|
Non-life-Threatening Emergency |
Within 6 hours |
|
Urgent Care |
Within 24 hours |
|
*Routine Care |
Within 5 business days |
|
*Follow-up Routine Care following discharge from hospital or emergency room visit. |
Within 5 business days |
Additional information on appointment access standards is available from your local Molina Quality Department toll free at (877) 872-4716.
Office Wait Time
Office wait times for scheduled appointments must not exceed 60 minutes, and all PCPs must monitor and meet this requirement.
After Hours
All Providers must have back-up (on call) coverage after hours or during the Provider’s absence or unavailability. Molina requires Providers to maintain a twenty-four (24) hour phone service, seven (7) days a week. This access may be through an answering service or a recorded message after office hours. For PCPs and OB/GYNs, if a recorded message is used, it must provide an option to direct the Member to a live person. The service or recorded message should instruct Members with an Emergency to hang-up and call 911 or go immediately to the nearest emergency room.
Please visit the Provider Manual for additional information on access and availability.
Thank you for your continued dedication to the community at large.
Provider Relations & Network Management
TO: Participating Primary Care Monroe Plan IPA and YourCare Primary Care IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 9/24/2025
SUBJECT: Annual Cultural Competency Training and Attestation
Partners in Achieving Health Equity
Training modules and resources are available to enhance cultural competency when serving diverse patient populations. These materials support staff in addressing disparities and improving health outcomes. Monroe Plan for Medical Care, IPA alongside Molina HealthCare of New York prioritizes provider support and is committed to health equity by adhering to the National CLAS Standards and meeting all regulatory and accreditation requirements related to equity.
Building culturally competent health care:
Resources for providers and staff Cultural competency can positively impact a patient’s health care experiences and outcomes. Cultural competency training modules and resources are available to providers and office staff. You can access the resources through Availity Essentials portal: Molina Healthcare | Availity Portal.
Cultural competency educational resources include:
- Cultural competency, including culturally and linguistically appropriate services (CLAS)
- Language access services, including effective communication strategies
- Health equity and disparities
- Social determinants of health
- Federal requirements, including the Affordable Care Act and the Americans with Disabilities Act
These resources offer tips for supporting diverse communities—racial, ethnic, cultural, linguistic, LGBTQIA+, older adults, people with disabilities, and immigrants/refugees. Training modules take 5–10 minutes; you can complete any or all. After finishing, log in to Availity Essentials, go to Molina Healthcare under Payer Spaces, select Resources, then Culturally and Linguistically Appropriate Services Provider Training Resources/Disability Resources and Links to submit your attestation form and view available materials.
You can also access the New York State approved training, titled Think Cultural Health, offers several provider specific programs online, at no cost: https://thinkculturalhealth.hhs.gov/education.
Providers and appropriate staff should complete this training in the next 12 months and annually thereafter. Once finished, please share your certificate of completion with us at providerrelations@monroeplan.com.
Be sure to review the bulletin and resource below to ensure cultural competency and compliance!
Click here to download: NYSDOH Cultural Competency Notice
Click here to download: Are You Culturally Competent?
Please forward the completed and signed attestation form to providerrealtions@monroeplan.com.
We appreciate your ongoing commitment to the broader community.
Provider Relations & Network Management
TO: Participating Primary Care Monroe Plan IPA and YourCare Primary Care IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 10/22/2025
SUBJECT: Quarterly Roster and Data Request
To ensure Monroe Plan for Medical Care and Molina Health Plan of NY have the latest information on all affiliated providers, please complete the roster available at this link: Monroeplan Roster Template and submit it to pfmemails@monroeplan.com.
If your office maintains a roster containing the required data elements, you may send your complete provider roster to pfmemails@monroeplan.com.
To maintain data integrity, Monroe Plan will be outreaching on a quarterly basis. Monroe plan will provide you with a group roster for you to validate upon request.
Please note: This does not replace routine provider enrollment forms and demographic change forms. These forms remain the most efficient method for enrolling and credentialing providers in a timely manner.
Monroe Plan Website: Provider Resources & Forms – Monroe Plan for Medical Care
It is imperative that data sites are up to date and current with your providers data. This includes CAQH and NPPES.
- NPPES: NPPES (hhs.gov)
- CAQH: CAQH ProView – Sign In
Upon submission of the roster, we will update our records to ensure Molina Health Plan has accurate information. If you have any questions, please feel free to contact us.
We appreciate your ongoing commitment to the broader community.
Provider Relations & Network Management
TO: Participating Primary Care Monroe Plan IPA and YourCare Primary Care IPA Network Providers
FROM: Monroe Plan for Medical Care and YourCare IPA Provider Relations Department
DATE: 01/05/2026
SUBJECT: Quarterly Roster and Data Request
To ensure Monroe Plan for Medical Care and Molina Health Plan of NY have the latest information on all affiliated providers, please complete the roster available at this link: Monroeplan Roster Template and submit it to pfmemails@monroeplan.com.
If your office maintains a roster containing the required data elements, you may send your complete provider roster to pfmemails@monroeplan.com.
To maintain data integrity, Monroe Plan wil be outreaching on a quarterly basis. Monroe plan will provide you with a group roster for you to validate upon request.
Please note: This does not replace routine provider enrollment forms and demographic change forms. These forms remain the most efficient method for enrolling and credentialing providers in a timely manner.
Monroe Plan Website: Provider Resources & Forms – Monroe Plan for Medical Care
It is imperative that data sites are up to date and current with your providers data. This includes CAQH and NPPES.
- NPPES: NPPES (hhs.gov)
- CAQH: CAQH ProView – Sign In
Upon submission of the roster, we will update our records to ensure Molina Health Plan has accurate information. If you have any questions, please feel free to contact us.
We appreciate your ongoing commitment to the broader community.
Provider Relations & Network Management
Network Compliance
- Cultural Competency
- Access and Availability
- Fact Sheet - Who could be at risk of losing Health Insurance
- Change Healthcare Service Disruption
Mainstream Medicaid Managed Care Providers are required to ensure the cultural competence of practice staff and to certify annual completion of New York State approved cultural competence training curriculum. The approved training, titled Think Cultural Health, offers several provider specific programs online, at no cost: https://thinkculturalhealth.hhs.gov/education. Providers and appropriate staff should complete this training in the next 12 months and annually thereafter. Once finished, please share your certificate of completion with us at providerrelations@monroeplan.com.
Be sure to review the bulletin and resource below to ensure cultural competency and compliance!
To be sure your practice is accurately represented in Molina’s (MHNY) Provider Directories, you will want to regularly submit updated rosters to pfmemails@monroeplan.com.
Thank you for your cooperation!
The fact sheet can be found on the NY State of Health website here.
Change Healthcare Service Disruption
Provider Frequently Asked Questions (FAQs)
Change Healthcare Service Disruption
Molina Healthcare, Inc.
March 20, 2024
On February 21, 2024, Change Healthcare (CHC), a subsidiary of Optum, took several services offline in response to a cybsersecurity incident. As soon as Molina Healthcare, Inc. (Molina) became aware that CHC experienced a cybersecurity incident, on February 21, 2024, we promptly disconnected our systems to CHC to ensure our own systems would remain secure. In addition, we immediately activated our Incident Response Plan team and contingency plans to manage any associated impact of the CHC incident to Molina, our network providers and our members. At this time, there is no indication Molina systems were compromised, nor has CHC notified us that Molina data has been compromised. As of the date of these FAQs, CHC has begun initial outreach to start the reconnection process with its customers.
Below are frequently asked questions related to the CHC service interruption and Molina contingencies. We will continue to share additional information as it becomes available.
General FAQs
- What Molina Healthcare, Inc. (Molina) services have been impacted in connection with the Change Healthcare (CHC) cybersecurity incident and outage?
For Molina, the Change Healthcare (CHC) incident impacted Electronic Claims Submission, and Payment and Settlement Services.
- I am a Provider impacted by the Change Healthcare (CHC) outage/incident. How can I get in touch with someone at Molina to assist me?
- Molina has established a dedicated contact center to assist providers impacted by the CHC outage. Agents can assist with claim(s) submission, emergency financial assistance requests, or other concerns related to the CHC outage. The contact center is available Monday-Friday from 5:00AM PST to 6:30PM PST. The contact center number is (844) 548-7684.
- Contact your state or market-specific Provider Services Contact Center.
- Contact your Molina Provider Services Representative.
- What alternative solutions are implemented to mitigate the impact on services and ensure continued support for members and providers?
Molina responded swiftly to the CHC incident to limit the impact to our provider community. We enacted our business continuity plan, which included alternative solutions to continue electronic claims intake and payment to providers.
Outlined below are the options for our providers until we deem it is safe to resume our regular processes with CHC:
- Clearinghouse Options:Providers utilizing CHC to submit claims to Molina prior to the outage may now do so via our alternate established connection with SSI Claimsnet, LLC (SSI Group) clearinghouse or another clearinghouse of their choice. Providers who are not directly utilizing CHC can and should continue utilizing their current clearinghouse for claims submission.
- Provider Portal:Our Availity Essentials provider portal solution was not impacted by this outage and remains available as another option to key-in claims for claims submission.
- Provider Payments:Molina has established a direct connection with ECHO, a CHC partner, to resume provider payment processing. ECHO has not been impacted by this outage. Payments are current.
- Eligibility:Molina has reestablished batch member eligibility verification (270/271) services using SSI Group, our alternate clearinghouse. In addition to online verification with SSI Group, eligibility verification continues to be available via the Availity Essentials portal, the Molina Contact Center and IVR. Molina’s member eligibility continues to be updated timely.
The following functions have not been impacted by the CHC incident:
- Authorization and Utilization Management:The process to request authorizations has not been disrupted and all utilization management decisions will follow our standard process.
- Notice of Admissions:The CHC incident has not impacted the notification of admissions process. Notice of an admission allows us visibility into the care of our members. Additionally, it allows us to assist with discharge planning to ensure our members have a smooth transition from acute care.
We are continuing to monitor the incident, and our contingencies, and will make any needed adjustments as appropriate, as the situation develops. Molina is committed to continue alternate provider claims submission and provider payment contingencies until such time as Molina has determined that the CHC services can be restored in a stable and secure manner. In preparation for reconnecting with CHC, we are establishing additional plans to limit disruption to our providers and members when that reconnection occurs.
We encourage providers to continue with their contingencies and alternate clearinghouse services. At this time, Molina’s alternate clearinghouse, SSI, will continue to accept claims from all clearinghouses.
Claims Submission
- How do I submit claims electronically?
- Providers not directly utilizing Change Healthcare (CHC) can and should continue utilizing their current clearinghouse for claims submission.
- Providers utilizing CHC to submit claims to Molina, prior to this outage, may now do so via our alternate established connection with SSI Claimsnet, LLC, or another clearinghouse of their choice.
- Our Availity Essentials Provider portal solution was not impacted by this outage and remains available as another option to key-in claims for claims submission.
- Register with SSI for claim submission via the Claimsnet’s Molina Provider Registration Form located online at: https://products.ssigroup.com/molinaregistrationportal/register
SSI dedicated contact center for Molina Providers 844-750-4274. - Providers can register with Availity Essentials to key-in claims for submission at: https://www.availity.com/molinahealthcare
Support is available with Availity at 1-800-AVAILITY (282-4548). Additional support resources:- How to register on the Availity Portal (incl. links to video, live webinar schedule and How To register): https://www.availity.com/documents/learning/LP_AP_GetStarted/index.html#/
- Availity’s page on self-service during this security incident: https://www.availity.com/availity-lifeline-self-serve-resources
- Availity’s Quick Reference Guide https://www.availity.com/documents/learning/QSG_Atypical_Registration.pdf
SSI has established connections to the following Molina Healthcare Plans:
| Health Plan | Payer ID | Health Plan | Payer ID | |
| Molina Complete Care of Arizona | MCC01 | Molina Healthcare of New Mexico | 09824 | |
| Molina Healthcare of California | 38333 | Molina Healthcare of Nevada | MLNNV | |
| Molina Healthcare of Florida | 51062 | Molina Healthcare of New York | 16146/SWHNY | |
| Molina Healthcare of Iowa | MLNIA | Molina Healthcare of Ohio | 20149 | |
| Molina Healthcare of Idaho | 61799 | Molina Healthcare of South Carolina | 46299 | |
| Molina Healthcare of Illinois | 20934 | Molina Healthcare of Texas | 20554 | |
| Molina Healthcare of Kentucky | 61325 | Molina Healthcare of Utah | SX109 (837P) 12X09 (837I) |
|
| Senior Whole Health of Massachusetts | SWHMA | Molina Complete Care of Virginia | MCC02 | |
| Molina Healthcare of Michigan | 38334 | Molina Healthcare of Washington | 38336 | |
| Molina Healthcare of Mississippi | 77010 | Molina Healthcare of Wisconsin | ABRI1 | |
| Molina Healthcare of Nebraska | MLNNE |
- I have not received confirmation of receipt or payment for a prior claim submitted on 2/21/24 or after?
If you have submitted electronic claims to Molina via a clearinghouse, on or after 2/21/2024, and have not received acknowledgement from Molina of receipt, we advise resubmitting those claims as soon as possible. This statement does not apply to providers submitting directly to SSI Group, UHIN, TMHP, COBA, or via our Availity portal solution.
- I registered with Molina’s alternate clearinghouse SSI. I am still not able to submit claims and have not received payment.
Contact the SSI dedicated contact center for Molina Providers at 844-750-4274 to confirm they have completed your Provider registration.
- I am currently submitting paper claims. Is there anything I need to do?
The process for paper claims submission has not changed, however, during this outage the process may be delayed. We encourage all our providers submitting paper claims to explore our electronic submission options.
- I am a Provider, and SSI rejected my claim submission(s). What should I do?
Molina is working closely with our alternate clearinghouse, SSI, to process claims smoothly. If your claim(s) submission was rejected since we announced SSI as our alternate clearinghouse, you will not need to resubmit your claim. SSI will automatically re-process your claim(s) submission. You will receive a confirmation from Molina once your claim has been received. If for some reason, you have not received a confirmation within 5 business days, please re-submit your claim(s) to SSI. If you continue to receive rejections, please contact Molina’s dedicated SSI support line at 1-844-750-4274 for 24 hour/7 day per week support.
- I am a Provider using the UHG iEDI clearinghouse. Will Molina be able to receive and process my claim(s)?
Yes. SSI Group, Molina’s alternate clearinghouse, does have a connection with the UHG iEDI clearinghouse. UHG iEDI can receive and transmit to us any Molina Healthcare claims they receive.
Claims Payment
- When will my claim be paid?
Molina utilizes ECHO, a CHC partner, to issue provider payments. ECHO has not been impacted by this outage. Molina has established a direct connection with ECHO and resumed provider payment processing. Payments are current.
- Will I receive 835 Electronic Remittance Advice Files?
835 Electronic Remittance Advice (ERA) files and Explanation of Payment (EOP) will be available as usual on providerpayments.com. 835 files will also be sent to any clearinghouse you currently have configured with ECHO. Please note there may be slight changes to the format of the EOP, however, all required data elements are available.
- Will I receive Explanation of Payment (EOP) files? Why is the usual information and/or notations is not on my EOP file?
Explanation of Payment (EOP) will be available as usual on providerpayments.com. Please note there may be slight changes to the format of the EOP, however, all required data elements are available. For example:
- Customer remit messages that populate as a results of claims remarks might display in a different format than previous.
- Patient Responsibility (PR) CARC may be more generic than our previously detailed CARC. However, PR will be clearly indicated on the PDF EOP via the remit message.
- For Marketplace, if a claim is denied and you are out of Molina’s network, the federal or state disclosures specific to the No Surprises Act will not be displayed. Communications related to these claims will be addressed separately.
- I am unable to access my Explanation of Payments (EOP) issued before 02/20/24. Why is that and what can I do?
- If you are an EFT provider, your Explanation of Payment (EOPs) documents are still be available on providerpayments.com. Please access them there.
- If you are a provider that was receiving checks or virtual cards, the PDF Explanation of Payment will not be available, as this is housed with Change Healthcare. We are working on an alternative solution and will provide an update when it is available.
- I do not use Change Healthcare (CHC) to submit claims, and I have not received payment?
Contact your clearinghouse and confirm they are submitting your claims to Molina’s alternate clearinghouse SSI (SSI Claimsnet, LLC).
- How many days a week are claims being paid?
Claims are being processed and paid according to the usual payment schedule.
- I am a Provider, and I don’t see my refund amount on the 835?
As a workaround, refund amounts can be found on the Explanation of Payment (EOP), until we are able to resume including that information in the 835 files.
- I am a Provider, and I am in financial distress due to the CHC outage?
Molina is here to help. Contact our dedicated contact center to assist providers impacted by the CHC outage, which is available Monday-Friday from 5:00AM PST to 6:30PM PST. The contact center number is (844) 548-7684.
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