Molinalogo

Points of contact and the process for joining our network will differ depending on the type of provider that you are. Please follow the instructions below for your provider type:

If your Contract Request Form is accepted, our Provider Contracting department will provide you with credentialing and contracting documents that must be completed. Documents you receive may differ depending on provider type, and may include:

• - Provider Agreement;
• - Provider Information Form;
• - Ownership and Control Disclosure Form;
• - W-9;
• - Practitioner Application (if practitioner does not have an updated and attested CAQH profile); and/or
• - Health Delivery Organization Credentialing Application

Upon receipt of completed documents, Provider Contracting will then begin the credentialing process.

Provider Contracting will work with Molina’s Credentialing department to credential the facilities and/or practitioners included in your completed documents. The credentialing process may take up to 90 calendar days to complete. Once credentialing is completed, you will receive a notification from Molina’s Credentialing department.

Note: You can help the credentialing process run smoothly, and perhaps even reduce the time it takes to credential, by making sure that you:

• - Complete and update practitioner CAQH information; and
• - Properly complete and sign the Ownership and Control Disclosure form

The final step will be for Molina to countersign your Provider Agreement and provide you with a signed copy. Credentialed facilities and/or practitioners will also be loaded into Molina’s claims payment system as in-network providers. The in-network effective date for each facility and/or practitioner will be the date of credentialing completion, which will be included in the notification that you will receive from Molina’s Credentialing department (referenced above in Step 3 – Credential).