Important provider resources and policies
Molina Policies
Molina Clinical Policies- Member rights & responsibilities
Providers must comply with the rights and responsibilities of Molina Members as outlined in the Molina Member Handbook and on the Molina website. The Member Handbook that is provided to Members annually is hereby incorporated into this Provider Manual. The most current Member Rights and Responsibilities can be accessed
Member Handbooks are available on Molina’s Member Website. Member Rights and Responsibilities are outlined under the heading “Your Rights and Responsibilities” within the Member Handbook document.
State and Federal Law requires that health care Providers and health care facilities recognize Member rights while the Members are receiving medical care and that Members respect the health care Provider’s or health care facility’s right to expect certain behavior on the part of the Members.
For additional information, please contact Molina at (844) 782-2678, 7:00 a.m. – 6 p.m. CT. TTY/TDD users, please call 711.
- Provider rights & responsibilities
Provider Rights
Providers have the right to:
- Be treated by their patients and other health care workers with dignity and respect.
- Receive accurate and complete information and medical histories for Members’ care.
- Have their patients act in a way that supports the care given to other patients and that helps keep the doctor’s office, hospital, or other offices running smoothly.
- Expect other network Providers to act as partners in Members’ treatment plans.
- Expect Members to follow their directions.
- File a complaint/grievance or file a Claim appeal against Molina.
- File a grievance with Molina on behalf of a Member, with the Member’s consent.
- File an appeal with Molina on the behalf of the Member, with the Member’s consent.
- Have access to information about Molina quality improvement programs, including program goals, processes, and outcomes that relate to Member care and services.
- Contact the Molina Provider Services department with any questions, comments, or problems.
- Collaborate with other health care professionals who are involved in the care of Members.
Provider Responsibilities
For Provider responsibilities in each area review Provider Manual
- Fighting Fraud, Waste, and Abuse
Proper Member identification is vital to reduce fraud, waste, and abuse (FWA) in government health care programs. The best way to verify a member’s identity is to obtain a copy of the Member’s ID card and a form of picture ID. Do you have suspicions of Member or Provider fraud? The Molina Alert Line is available to you 24 hours a day, seven days a week, even on holidays at (866) 606-3889. Reports are confidential, but you may choose to report anonymously.
Molina complies with all Federal and State requirements regarding fraud and abuse, including but not limited to, sections 1128, 1156, and 1902(a)(68) of the Social Security Act.
Additional information of Fraud, Waste and Abuse is available in the Compliance section of this Provider Manual.