Molinalogo

Can I submit COB claims electronically?
Yes, Molina and our connected Clearinghouses fully support electronic COB.

Do I need to submit a certain volume of claims to send EDI?
No, any number of claims via EDI saves both time and money.

Which Clearinghouses are currently available to submit EDI claims to Molina?
See Clearinghouses

What claims transactions are currently accepted for EDI transmission?
837P (Professional claims), 837I (Institutional claims).

Where can I find more information on the HIPAA transactions?
See companion guides and State Guide websites

How do I exchange the 270/271 Eligibility Inquiry?
Molina does not directly exchange the Eligibility transactions. The transactions may be sent to Molina's contracted clearinghouse The SSI Group to verify Eligibility.

How do I exchange the 276/277 Claim Status Inquiry/Response?
Molina does not directly exchange the Claim Status transactions. The transactions may be sent to Molina's contracted clearinghouse The SSI Group to verify Claim Status.

What is the procedure for the reimbursement of covered services?
As a participating Molina  provider, each provider agrees to bill all covered services provided to Molina members on the required forms and/or electronic claims file format. All claims should be billed on a fully completed CMS 1500, UB04 and/or CMS 1450 to be considered for adjudication and/or payment. Providers may visit the Centers for Medicare and Medicaid Services (CMS) to obtain more information about these forms and/or for more instruction and/or information on the proper use of claims forms for services.

Any claims requiring authorization should include the medical authorization number in the appropriate field of the CMS 1500, UB04 or CMS 1450 to assist with appropriate claims processing and timely claims payment. For a list of services requiring prior authorization, please visit our provider tools and resources on www.MolinaHealthcare.com/AZ, or as indicated, please reference Section 9: Medical Management of the Molina provider manual.

What do I do if I still have questions?
Contact Us