Introduction to the Provider Manual
This manual provides essential information for healthcare providers participating in Molina Healthcare's Medicare Advantage plans for 2021. It details the structure of Medicare Advantage products, outlines provider responsibilities, and explains key processes for claims, compliance, and member services. Molina Healthcare is committed to delivering quality healthcare services and ensuring a smooth experience for both providers and members.
Key Information for Providers
- Plan Details: Comprehensive overview of Molina Medicare Complete Care (HMO SNP) and other Medicare Advantage plans, including regulatory changes impacting Dual Eligible Special Needs Plans (D-SNPs).
- Provider Responsibilities: Guidelines on nondiscrimination, data accuracy, and compliance with federal regulations such as the Affordable Care Act (ACA) and Americans with Disabilities Act (ADA).
- Contact Information: Direct access to various departments including Provider Services, Member Services, Claims, Compliance, Credentialing, and the Nurse Advice Line.
- Electronic Solutions: Emphasis on utilizing electronic tools for claims submission, payment, and inquiries to improve efficiency and compliance. Key resources include the Provider Portal and information on EFT/ERA requirements.
Resources and Support
For the most current information and resources, providers are encouraged to visit the official Molina Healthcare website at www.MolinaHealthcare.com. The Provider Portal (https://provider.MolinaHealthcare.com) offers a convenient platform for managing information and submitting requests.