Get Molina Reconsideration Form

Some of the benefits that are offered to you as a Molina Dual Options Cal MediConnect member are doctor visits, inpatient hospital care*, skilled nursing facilities*, wellness visits, mammograms, and much more - all with $0 copay!

Sterilization (Tubal Ligation or Vasectomy) Covered for patients 21 years of age or older. Consent to Sterilization form required except in unique circumstances of an unscheduled clinical event that requires sterilization because of a life-threatening emergency.

and claims processing. Retroactive eligibility occurs when a member's effective date of coverage is back-dated by the state. This can happen for various reasons.

A redetermination is the first level of the appeals process and is an independent re-examination of an initial claim determination. A claim must be appealed within 120 days from the date of receipt of the initial Medicare Summary Notice (MSN), Remittance Advice (RA) or Overpayment Demand Letter.

STEP 1 - Molina Healthcare Appeal You may fax the information to (877) 814-0342. Within 5 calendar days, we will let you know in writing that we got your appeal. We can help you file your appeal. If you need help filing an appeal, call (800) 869-7165 (TTY 711).

For providers in all networks As a reminder, on Jan. 1, 2019, Molina Healthcare updated the Authorization Reconsideration process. Pre-service and post-service authorization reconsiderations have been combined into a single process, and claims reconsiderations now follow a separate process.

Through Medicaid services, a referral is issued in writing by your primary care physician when he or she feels it is necessary for you to visit another health care provider for treatment or tests. A prior authorization for this referral is necessary in some cases.

Please contact the Provider Call Center for claims status information at (855) 322-4077, Monday Friday 8:00 a.m. 5:00 p.m. EST; you may inquire about three (3) claims per call. billed for the service(s). or submit an e-mail to EDI.Claims@MolinaHealthcare.com.

One, beneficiaries with Original Medicare, with or without Medicare supplement insurance, generally do not face prior authorization requirements for doctors' visits, hospitalizations, diagnostic studies, or treatments. The Centers for Medicare and Medicaid Services (CMS) has two "prior authorization required" lists.