Molina Healthcare Provider Network Overview

Molina Healthcare offers a comprehensive provider network in Mississippi, focusing on delivering high-quality healthcare services to its members. Learn about joining their network, centralized credentialing process, vision, mission, and the key to successful collaboration. Access their website for more details and contact information.

Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

• Healthcare Services
• Provider Network
• Credentialing
• Collaboration
• Mississippi

love Follow

Uploaded on Apr 05, 2024 | 1 Views

Presentation Transcript

1. Molina Healthcare 2023 MGMA Insurance Forum

2. Agenda About Molina Joining Our Provider Network Provider Services Provider Contact Center Healthcare Services Prior Authorizations Claims Provider Website Provider Web Portal Provider Resources 2 2

3. Molina Healthcare of Mississippi Location 188 East Capitol Street, Suite 700 Jackson, MS 39201 3 3

4. About Molina Healthcare Our Vision We will distinguish ourselves as the low cost, most effective and reliable health plan delivering government-sponsored care. Our Mission We improve the health and lives of our members by delivering high-quality health care. 4 4

5. Collaboration is Key Network Strategy &Services Healthcare Services Compliance Molina Healthcare of Mississippi Quality Improvement & Risk Adjustment Provider Contact Center Pharmacy 5

6. Joining Our Provider Network All out-of-network providers must obtain a PA prior to rendering all services. All Non-Par Providers require authorization regardless of services or codes. To join our network, please complete the Contract Request Form found on our website at https://www.molinahealthcare.com/providers/ms/medicaid/for ms/Pages/fuf.aspx and follow the instructions given. After completing, a representative from our Provider Contracting Department will reach out to you regarding the enrollment and credentialing process. For additional information, email MHMSProviderContracting@MolinaHealthCare.Com 6

7. DOM Centralized Credentialing Beginning July 1, 2022, providers seeking to join as providers in MississippiCAN will no longer have to credential individually with each CCO. For an interim period from July 1-Aug. 15, 2022, providers will simply need to follow DOM s screening process used for Medicaid fee-for-service instead of completing managed care-specific credentialing. (For technical reasons, CHIP providers will have to enroll with each CHIP CCO during the interim period.) This approach will offer immediate administrative relief as the new system is configured to handle all credentialing. Providers seeking to enroll during the interim period will be required to submit all necessary screening documentation to the current system, Envision, by August 15, 2022. In order to ensure a smooth transition, DOM will temporarily suspend enrollment from August 15 until the new system MESA goes live. Please access the link below for additional details. https://medicaid.ms.gov/wp-content/uploads/2022/06/June-2022-Provider- Bulletin.pdf 7

8. Provider Field Services Provider Services is the provider facing department responsible for the education and training of the Molina provider community. As the liaison between the provider and the health plan, provider services representatives conducts onsite visits, gathers and researches claim issues, offer training on DOM policies and procedures as well as responds to telephone and written inquiries from providers and web portal assistance. The department has Provider Services Representatives who serve all providers in Molina Healthcare of Mississippi s provider network. Providers may contact the Provider Services Contact Center to locate the Provider Services Representative that serves their local area. 8

9. Meet Our Team Provider Services Representatives Ricky Bailey-Sr. Provider Services Representative North MS and TN Ricky.Bailey@MolinaHealthcare.com 901-515-6703 Robin Thomas-Sr. Provider Services Representative Southwest MS and LA Robin.Thomas@MolinaHealthcare.com 601-960-4041 Parren Clark-Sr. Provider Services Representative MS Delta and AR Parren.Clark@MolinaHealthcare.com 601-937-5871 Terri Smith-Sr. Provider Services Representative South MS, AL, and LA Terri.Smith2@MolinaHealthcare.com 601-520-5034 Tamalia Williams-Sr. Provider Services Representative FQHCs and RHCs Tamalia.Williams@MolinaHealthcare.com 601-862-6468 Laterria Lacy-Sr. Provider Services Representative Central MS and Southeast MS Laterria.Lacy@MolinaHealthcare.com 601-559-3142 Kesia Mays-Provider Services Representative Behavioral Health Kesia.Mays@MlolinaHealthcare.com 601-937-2031 Mary A. Simmons-Provider Services Representative Behavioral Health (PRTFs and CMHCs) Maryann.Simmons@MolinaHealthcare.com 601-874-4961 Leadership Tiffany Hollis-Johnson- Director Provider Services Tiffany.Hollis-Johnson@MolinaHealthcare.com 601-647-9086 Candy Williard-Director Provider Engagement Candy.Williard@MolinaHealthcare.com 601-850-1079 Candice Pippins- Manager All Specialties Candice.Pippins@MolinaHealthcare.com 601-947-3437 LaKeida Ward- Manager Behavioral Health, FQHCs, and RHCs LaKeida.Ward@MolinaHealthcare.com 601-317-4313 MHMSProviderServices@MolinaHealthcare.com (General Provider Services) MSBHProviderServices@MolinaHealthcare.com (Behavioral and Mental Health Services) 9

10. Initial Provider Orientation Initial Provider orientation training shall be scheduled and conducted within thirty (30) days following the date that provider is deemed to be active. An active provider is one who has completed the contracting and credentialing processes and has been configured and loaded into Molina's system. Provider Field Services will facilitate the initial orientation. 10

11. Provider Services Contact Center The Provider Service Contact Center is the first line of communication for providers. Provider Services Contact Center can verify eligibility, answer claims related questions, check Prior Authorizations status, etc. Located in Mississippi Phone: (844) 826-4335 Hours of operations 7:30 am 6:00 pm CST 11

12. Healthcare Services Health Care Services at Molina consists of multiple teams The teams must work together in an integrated approach to provide quality care and excellent customer service to our members and providers Utilization Management Member & Provider Appeals Medical Claims Review Care Management 12

13. Care Management Support 13

14. Prior Authorizations Prior Authorization is required for all outpatient surgery and identified procedures, non-emergent inpatient admissions, Home Health, some durable medical equipment and Out-of-Network Professional Services. Molina requires notification of all emergent inpatient admissions within twenty-four (24) hours of admission or by the close of the next business day when emergent admissions occur on weekends or holidays. For emergency admissions, notification of the admission shall occur once the patient has been stabilized in the emergency department. Notification of admission is required to verify eligibility, authorize care, including level of care (LOC), and initiate inpatient review and discharge planning. Emergent inpatient admission services performed without meeting notification and Medical Necessity requirements or failure to include all of the needed documentation to support the need for an inpatient admission will result in a denial of authorization for the inpatient admission. Requests for services listed on the Molina Healthcare Prior Authorization Guide are evaluated by licensed nurses and clinicians that have the authority to approve services. 14

15. Prior Authorizations Web Portal: https://www.availity.com/molinahealthcare Phone: (844) 826-4335. Please follow the prompts for prior authorization. Note: For telephonically submitted requests, it may be necessary to submit additional documentation before the authorization can be processed. Fax: Prior authorization requests may be faxed to the Healthcare Services Department using the Molina Healthcare Service Request Form which is available on our website at: MolinaHealthcare.com. Prior Authorizations: Phone: 1 (844) 826-4335 Inpatient Requests Fax: 1 (844) 207-1622 All Non-Inpatient Fax: 1 (844) 207-1620 Note: Please indicate on the fax if the request is non-urgent or expedited/urgent. Please see the MHMS Provider Manual for definition of expedited/urgent. Mail: 188 East Capitol Street Suite 700 Jackson, MS 39201 15

16. Prior Authorizations https://www.molinahealthcare.com/providers/ms/medicaid/forms/~/media/Molina/ PublicWebsite/PDF/Providers/ms/medicaid/PA-Guide-Request-Form.pdf . 16

17. Prior Authorization Look Up Tool Our Prior Authorization Look Up Tool allows providers to search specific CPT codes to determine if prior authorization is required. 17

18. Prior Authorization Look Up Tool Our Prior Authorization Look Up Tool allows providers to search specific CPT codes to determine if prior authorization is required. 18

19. Peer-to-Peer Review Process Peer-to-Peer review of an adverse determination may be requested if the Provider directing the Member s care wishes to provide additional information related to the authorization request. The requesting Provider has five (5) business days from the receipt of the denial notification to schedule the review. Requests can be made by contacting Molina at (844) 826-4335 19

20. Claim Submission Timeframes MSCAN/CHIP Claim Submission Timeframe Initial Claim 180 Days from the DOS/180 Days from the Date of Discharge Reconsideration/ Correction/Adjustment 90 Days from the date of denial/EOP COB 180 Days from the Primary Payer s EOP Appeals 90 Days to file dispute; 30 days to file appeal from the dispute resolution letter date 20

21. Claim Submission Timeframes - Marketplace Claims Submission Time Frame Initial Claim 180 Days from the DOS/180 Days from the Date of Discharge Reconsideration/ Correction/Adjustment 30 Days from the date of denial/EOP COB 180 Days from the Primary Payer s EOP Appeals 180 Days from Receipt of Adverse Determination 21

22. Claim Submission Electronic Claims (preferred method) Paper Claims The Provider Portal (https://www.availity.com/molinahealthcare) is available free of charge and allows for attachments to be included. Claims Mailing Address Clearinghouse Molina Healthcare of Mississippi, Inc. PO Box 22618 Long Beach, CA 90801 Providers may use the Clearinghouse of their choosing. (Note that fees may apply). ClaimsNet is Molina Healthcare s chosen clearinghouse. When submitting EDI Claims (via a clearinghouse) to Molina Healthcare, providers must use the applicable payer ID # 77010 Claims mailed to our Jackson, MS office will be returned unprocessed. 22

23. Electronic Funds Transfer & Remittance Advice (EFT & ERA) Contracted Providers are required to register for EFT within 30 days of entering the Molina Network. Providers enrolled in EFT payments will automatically receive ERAs as well. Molina partners with Change Healthcare ProviderNet for EFT and ERA services. Additional information regarding EFTs and ERAs will be available under the EDI, ERA/EFT tab on the Molina website at MolinaHealthcare.com/provider. Benefits of EFT/ERA: Faster payment (as little as 3 days from the day the claim was electronically submitted) Search historical ERAs by claim number, member name, etc. View, print, download and save PDF ERAs for easy reference Providers can have files routed to their ftp and/or their associated clearinghouse How to Enroll: To register for EFT/ERAs with Change Healthcare go to: https://providernet.adminisource.com/Start.aspx Step-by-step registration instructions are available on Molina s website (www.molinahealthcare.com/provider) under the EDI, ERA/EFT tab. 23

24. Provider Secure Web Portal Molina has transitioned to Availity s Web Portal platform. The Secure Web Portal is still available to you 24/7! https://www.availity.com/molinahealthcare View Member Eligibility Submit and View Claim Status Obtain PCP Member Rosters View your HEDIS Performance Submit and View PA Authorizations coming soon! And More! 24

25. Provider Secure Web Portal Providers are NOT required to use Availity as a clearinghouse. We have transitioned to Availity s platform for our web portal only. https://www.availity.com/molinahealthcare The Availity Client Services (ACS) number is (800) 282-4548. Help with Availity (including the ACS phone number) are available by clicking Help & Training | Get Trained in the Availity portal. Assistance is available Monday through Friday from 8 a.m. ET 8 p.m. ET. 25

26. Provider Resources Provider Manuals can be found at: https://www.molinahealthcare.com/providers/ms/medicaid/PDF/MS-Medicaid- Provider-Manual.pdf https://www.molinahealthcare.com/providers/ms/marketplace/manual/Pages/pro vd.aspx Our Provider Call Center is available to answer provider inquires and questions by calling (844) 826-4335, Monday Friday, 7:30 am 6:00 pm Our website is available at MolinaHealthcare.com For additional assistance or questions, please feel free to reach out to our Provider Services team at MHMSProviderServices@MolinaHealthcare.com 26

27. Questions 27