Resources & Training
Availity Essentials Resources
Availity Core Features
Secure Messaging
Accessing Remittance Information
Enhanced Claim Reporting
Checking Member Redetermination Status
Medicaid Redetermination & Unwinding
Since the start of the Public Health Emergency, continuous coverage requirements had kept Medicaid members covered with no required renewal. The continuous coverage requirement ended on April 1st, 2023. Members will need to complete a renewal between June 2023 and May 2024 to keep their benefits and coverage.
We’re asking for your support and partnership. Together, we can provide the education and resources to retain Medicaid members and offer solutions to those in our communities who have lost their coverage during the recertification process.
Molina is here to assist with member facing materials such as wallet cards, posters, and mailings, including co-branding and/or translation if needed, and community focused events.
Reach out to MHWIProviderNetworkManagement@MolinaHealthcare.com if you are interested in partnering with Molina on any redetermination activities.
Redetermination FAQ Redetermination Video
Sample Redetermination Materials
All materials are available for cobranding and in a variety of translations
Redetermination Flyer
Redetermination Wallet Card
MCG Advanced Imaging Auto Authorization
Molina has implemented a self-service method for our Medicaid and Marketplace lines of business to submit Advanced Imaging Prior Authorization requests. This system can be accessed electronically via the provider portal and will be available 24 hours per day, 7 days per week. This method of submission will be an alternative to the existing fax / phone / email process.
This system will provide more efficient processing of your authorization request, and the status of the authorization will be available immediately upon completion of your submission.
MCG Cite Auth-Authorization Step by Step Instructions
Optum Pause & Pay
Optum, a vendor utilized by Molina, will perform prepayment medical record reviews using national guidelines for billing practices to ensure uniform billing across all payers. Molina refers to this process as Pause & Pay. To learn specifics about what is reviewed during the Pause & Pay process and how it impacts you as a provider, reference the FAQ below.
If you have additional questions about Optum Pause & Pay, reach out to MHWIProviderNetworkManagement@MolinaHealthcare.com.
Wisconsin Statewide Health Information Network (WISHIN)
The Wisconsin Division of Medicaid Services (DMS) has been working with WISHIN and managed care organizations (MCOs) to develop a standardized format to share the MCOs’ care plans for their SSI members through WISHIN. As a result, Molina Healthcare’s SSI Medicaid care plans are now viewable on the WISHIN Pulse Portal.
The goal of having viewable care plans on WISHIN’s health information exchange is to:
· Enhance the sharing of health information across the healthcare continuum to improve quality of care and cost management
· Provide access to care management information to fill data gaps related to medication, member goals, and social determinants of health
· Support providers’ efforts to meet Meaningful Use requirements, specifically measures surrounding the reconciliation of clinical information
· Expand access to discrete clinical data for quality-measurement purposes
We encourage providers to access our member care plans and collaborate with our Care Management staff to support our members in receiving quality care. Care plans can be accessed on the WISHIN Pulse Site by selecting the Documents tab on the left side of the page of the Patient Summary.
If you are new to WISHIN and interested in joining, check out their website.
Hierarchical Condition Category Coding (HCC) Coding Education
In an effort to add value to our contracted physicians' offices we have produced HCC Coding Education. We are utilizing our best information to give you concise tips on how best to identify, code and document your patients' health status.
This information is pertinent to not only Molina Healthcare members, but to all of your insurance lines of business that you and your colleagues accept in your office.
Take a moment to review the HCC Coding Education below
Systolic and Diastolic Heart Failure