September 12, 2024
Medicare Contract Consolidation
As part of the ongoing Molina Healthcare of Wisconsin, Inc. and My Choice Wisconsin by Molina Healthcare integration, effective January 1, 2025, the Molina and My Choice Wisconsin Medicare products will be combined.
The combined Medicare Dual Advantage product will be administered through legacy My Choice Wisconsin channels and platforms.
Why will the Medicare product be administered on My Choice systems?
- High quality patient care as shown through higher Star ratings: The legacy My Choice Wisconsin plans have consistently achieved higher Medicare Star Ratings, reflecting superior quality and member satisfaction.
- Streamlined Administration for Intertwined Benefit Programs Until January 2026: Integrating Molina’s Medicare contracts into a unified system with My Choice Wisconsin allows for more efficient management of benefits, claims and provider networks while the Family Care/Family Care Partnership products are still on the My Choice system.
- Regulatory compliance: This move aligns with our broader strategy to meet regulatory requirements and improve overall operations efficiency.
What does this mean for you?
Contracting
- If you're contracted with both Molina and My Choice for Medicare, your Molina contract rate will supersede.
- If you're contracted only with Molina for Medicare, your contract will be integrated into My Choice systems.
- If you're contracted only with My Choice for Medicare, there will be no changes to your daily operations.
This does not impact or change your existing contracts with Molina for Medicaid BadgerCare Plus and/or SSI, or My Choice for Family Care and/or Family Care Partnership.
Provider Demographics & Contact Information
- Molina and My Choice are actively collaborating to integrate our data and ensure consistency between the two platforms.
- Continue to send your provider data rosters and demographic information to MHWIProviderNetworkManagement@MolinaHealthcare.com for all lines of business.
- After January 1, 2025, Medicare members and providers will use the My Choice Provider Online Directory to locate in-network providers for Medicare.
Operational Changes
Effective January 1, 2025:
- Providers must follow the prior authorization guidelines published by My Choice Wisconsin. Our team is currently reviewing and streamlining consistency where possible. More information to come.
- The My Choice Wisconsin brand is changing to My Choice Wisconsin by Molina Healthcare. There are no changes other than the look and feel of our communications.
- All Medicare Dual Advantage members will be covered under My Choice Wisconsin by Molina Healthcare and will present with a new ID card.
The My Choice Wisconsin and Molina provider teams will continue to support you as one cohesive team. Training opportunities, resources, and detailed communications will follow.
Thank you for your continued support and cooperation as we move through these integration phases. If you have any questions or concerns, please direct them to MHWIProviderNetworkManagement@molinahealthcare.com.