How to Become Molina Provider?

Molina offers managed healthcare services to Medicaid and Medicare recipients, as well as through state insurance exchanges. Molina made a significant impact in the field of health care with it’s locally owned and operated health plans. Through government programmes such as Medicaid and Medicare, it now provides Medicare health care plans and healthcare insurance to low-income people. Molina Healthcare concentrates on low cost health care programmes, although it also offers a variety of HMO marketplace healthcare plans.

Our Specialist will help you get Enrolled

We recognize that certification has a significant financial impact. We can assist you whether you have a new provider or simply need assistance with regular credentialing chores. We provide community members identity management services. We provide healthcare workers with a simple and safe way to access major local health care plans and hospitals’ provider portals, as well as other useful online services. Rather than making wasting time or entering into several websites, our members can contact us to get information from all collaborating organizations.

What makes us special?

• Accomplish credentialing more quickly

• Improve provider access to reliable information

• Improve provider access to reliable information

• Increase provider satisfaction

• Increase revenue faster

Molina Credentialing Requirements

Who Should Be Credentialed

All licensed independent professionals or groups of practitioners that provide care to Molina Healthcare members must meet credentialing standards. The categories of practitioners with whom Molina Healthcare may engage are not addressed in its criteria.

Practitioners who must be credentialed

The following sorts of practitioners were required to be credentialed by Molina Healthcare: Practitioners having a non-hierarchical relationship to the organization. When an organization chooses and directs its members to attend a certain practitioner or group of practitioners, the relationship is independent. Practitioners who see patients in places other than inpatient hospitals or ambulatory freestanding facilities. Hospital-based practitioners who visit Molina Healthcare clients as a result of their autonomous partnership with the company. Practitioners who are covered Practitioners who do not treat patients in a treatment facility.

Documents Required For Credentialing

Molina Healthcare must ensure that the following components are present and that they are completed within the specified time frames:
a. Verification of education
b. Verification of training
c. Verification of board of certification if a provider claims to be Board-certified on the application.
d. A history of professional liability lawsuits that culminated in settlements or judgments made by or on account of the practitioners
e. Verification of work history
f. License verification
g. Disclosure form

Molina Provider Enrollment Procedure
Molina Credentialing Application

The applicant will be responsible for providing sufficient information for a proper evaluation of his or her expertise, background, training, demonstrated ability, and ability to provide facilities without restrictions, including physical and mental health status as permitted by law, and for attempting to resolve any doubts about these or any of the other basic qualifications required by Molina. Each asking practitioner with whom Molina Medical has chosen to establish a commercial partnership receives an unsigned contract and registration packet from Network Development. The application bundle will include the application form, release and consent paperwork, as well as instructions for filling out and submitting credentialing data to Molina Healthcare. Despite the fact that the applicant’s contracted medical group may deliver the completed application form to the Credentialing Manager, the applicant is responsible for filling out all of the information and supplying the necessary evidence. Once the applicant has completed the Formal Review /credentialing Review process, the contract is fully executed.

Molina Credentialing Application Form

The applicant’s signature the application must be filled out completely by the applicant. Every application for Molina Health Provider must include current information, be filed on the Governing Board’s prescribed written application form, and be complete. The application must include at least the following information:

• A copy of his or her current, valid license or certificate to practice his or her profession.

• A recent, valid certificate, as well as a copy of the certificate, if necessary.
Documentation of professional liability insurance with a minimum aggregate coverage level applicable to the medical practice under contract. This coverage will apply to Molina Care members as well as the applicant’s efforts on behalf of Molina Healthcare. The insurance company’s name and expiration date must be supplied.
A compilation of all malpractice actions, with justifications and current status, for at least some previous years.

• Education

• If appropriate, Board Certification status

• Academic history

• Including prestigious institution, graduation year, and degree.

If the information provided in the application is assessed by the Peer Credentialing Review panel to be sufficient to make a determination of the professional’s qualifications or current competence, the credentialing process will be done within 45 working days of application submission, except if extenuating conditions exist (i.e. validation of education is delayed). If any time-sensitive application information and/or verification, as described by current guidelines, becomes more than one hundred eighty (180) calendar days old before the Peer Review/Credentialing Committee makes a final decision onthe applicant, up to date information must be obtained and included in the application review.

What to expect

Our simplified system expedites the approval of your credentialing application. We know what to say and do in order to get accurate results quickly! Let’s chat about your requirements and build a firm plan after you’ve completed the form. Collect your documents to save energy / cost, have everything ready at the same time. From there, we’ll take care of everything! Take a seat and unwind.

Molina Re-credentialing

The practice of periodically assessing and certifying your professional credentials in accordance with Magellan’s credentialing requirements is known as Re-credentialing.

Molina endorses the Commission for Affordable Quality Healthcare’s (CAQH) online universal credentialing procedure as the most convenient option for practitioners to promote effective and timely Re-credentialing. Please ensure that Molina has access to your credentialing information and that you have reviewed, updated, and attested to the completeness and accuracy of the application and all additional documentation. Molina may require extra documentation to finalize the re-credentialing process, depending on your specific scenario. Please respond to Molina’s demands promptly and completely to prevent jeopardizing your network participation status.

The process of re-credentialing encompasses, but is not restricted to:

Application evaluation — we double-check that you’ve completed all sections of the form and sent in all required attachments.

Credentials verification – We check and verify information such as the status of your license and malpractice insurance coverage, among other things. The Regional Network and Credentialing Committee (RNCC), which is made up of Molina clinical personnel and professional peers, reviews Re-credentialing. Re-credentialing applications and any supplementary information are reviewed by the RNCC.

You may get a notification letter after successfully completing the Re-credentialing process. If you don’t hear anything, it’s likely to believe your credentials were confirmed.

Contact information
Phone number
(855) 322-4082