Electronic Data Interchange (EDI)
Molina 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
- Nevada Clearinghouse Information
Change Healthcare
Phone Number
(877) 469-3263Transaction Type/Format
CMS-1500 - Professional (837P)
UB04 - Institutional (837I)
Eligibility Batch Inquiry/Response (270/271)
Claims Status Batch Inquiry/Response (276/277)Payer ID
MLNNV - 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 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’s contracted clearinghouse (see the Clearinghouse Information section for Payer ID information). If you do not have a Clearinghouse, Molina 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 does not directly exchange 270/271 and 276/277 transactions. The 270/271 and 276/277 transactions are handled by Molina’s contracted clearinghouse Change Healthcare. The transactions may be sent directly to Change Healthcare 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
- 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 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 does not directly exchange the Eligibility transactions. The transactions may be sent to Molina’s contracted clearinghouse Change Healthcare to verify Eligibility. *New York Providers will continue to submit transactions through Claimsnet.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 Change Healthcare to verify Claim Status. *New York Providers will continue to submit transactions through Claimsnet.What do I do if I still have questions?
Contact us (see below Contact Us section). - Contact Us
To submit paper claims, please mail to:
Molina Healthcare of Nevada, Inc.
PO Box 22666Long Beach, CA 90801
If you have question, contact Molina Healthcare at (833) 685-2103.
EDI Technical Assistance: If you are currently submitting via Change Healthcare you should have a login for ON24/7 website. ON24/7 is a web-based system that allows Change Healthcare customers to submit service requests and check on the status of those requests 24 hours a day, 7 days a week. Please contact Change Healthcare directly at (866) 506-2830 or Visit the ON24/7 website
For questions about any of the following areas, please select the appropriate link:
Submitting Electronic: Claims, Referral Certification and Authorization
Email Directly: EDI.Claims@MolinaHealthcare.comSubmitting Electronic: Encounters
Email Directly: EDI.Encounters@MolinaHealthcare.comReceiving 835/ERAs
Email Directly: EDI.eraeft@MolinaHealthcare.com