Electronic Data Interchange (EDI)
Molina Healthcare supports our providers, and as such would like to highlight the many benefits of electronic claims submission that will have direct impact on your time! EDI will help:
- Efficient information delivery
- Reduce operational costs associated with paper claims (printing, correlating, and postage)
- Increase accuracy of data
- Ensure HIPAA compliance
- Iowa Clearinghouse Information
SSI/Claimsnet
Phone Number
(800) 356-0092Transaction Type/Format
CMS-1500 - Professional (837P)
UB04 - Institutional (837I)
Eligibility Batch Inquiry/Response (270/271)
Claims Status Batch Inquiry/Response (276/277)Payer ID
MLNIA - Companion Guidance Information
Molina Healthcare - 5010
*Please Note: This information is supplied for informational purposes only. Molina Healthcare does not guarantee the accuracy of these documents.
- Submitting EDI Transactions
Types of EDI Transactions
Electronic Data Interchange (EDI) functionality is utilized by Molina Healthcare to complete several types of ASC X12N Version 5010 transactions, including:
- Claims Submission (837 Professional and Institutional Healthcare Claims)
- Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) – (835 Healthcare Claim Payment/Advice)
- Referral Certification and Authorization (278 Healthcare Services Review - Request for Review and Response)
- Eligibility for a Health Plan (270/271 Healthcare Eligibility Benefit Inquiry and Response)
- Claims Status (276/277 Healthcare Claim Status Request and Response)
EDI Claims Submission
The easiest way to submit EDI claims to Molina Healthcare is through a Clearinghouse. You may submit the EDI claims through your own clearinghouse or use Molina Healthcare’s contracted clearinghouse (see the Clearinghouse Information section for Payer ID information). If you do not have a Clearinghouse, Molina Healthcare offers additional electronic claims submissions options. Log on to Availity's Provider Portal for additional information about claims submission options available to you.
270/271 Healthcare Eligibility Benefit Inquiry and Response & 276/277 Healthcare Claim Status Request and Response
Molina Healthcare does not directly exchange 270/271 and 276/277 transactions. The 270/271 and 276/277 transactions are handled by Molina Healthcare’s contracted clearinghouse SSI. The transactions may be sent directly to SSI or via your own clearinghouse
EDI Forms
278 Referral Certification and Authorization Form
The 278 Request transaction is utilized to verify medical necessity for health care services; therefore, additional supporting documentation may be necessary for approval of requested services.
- EDI Website Links
- CMS: Centers for Medicare & Medicaid Services
- Wedi-Snip: Workgroup for Electronic Data Interchange - Strategic National Implementation Process
- WPC: Washington Publishing Company
State/Commonwealth Links
- Arizona Department of Health Services
- California Department of Health Services
- Florida Medicaid A Division of the Agency for Health Care Administration
- Idaho Department of Health and Welfare
- Illinois Department of Healthcare and Family Services
- Iowa Department of Human Services
- Kentucky Division of Medicaid Services
- Massachusetts Department of Public Health
- Michigan Department of Community Health
- Mississippi Division of Medicaid
- Nevada Department of Health and Human Services
- New Mexico Human Services Department
- eMedNY
- Ohio Department of Job and Family Services
- Texas Medicaid Healthcare Partnership
- South Carolina Department of Health and Human Services
- Utah Department of Health
- Virginia Department of Medical Assistance Services
- Washington State Department of Social and Health Services
- Wisconsin Department of Health Services
- Frequently Asked Questions
Can I submit COB claims electronically?
Yes, Molina Healthcare 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 section.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 sectionsHow do I exchange the 270/271 Eligibility Inquiry?
Molina Healthcare does not directly exchange the Eligibility transactions. The transactions may be sent to Molina Healthcare’s contracted clearinghouse SSI/Claimsnet to verify Eligibility.How do I exchange the 276/277 Claim Status Inquiry/Response?
Molina Healthcare does not directly exchange the Claim Status transactions. The transactions may be sent to Molina Healthcare’s contracted clearinghouse SSI/Claimsnet to verify Claim Status.What do I do if I still have questions?
Contact us (see below Contact Us section). - Contact Us
Molina Iowa Provider Services Contact Center:
Call: (844) 236-1464
Email Directly: IAProviderRelations@MolinaHealthcare.com