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
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
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!
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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