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  • Practitioner Information Form - Molina Healthcare

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Molina Healthcare of New Mexico, Inc. APPLICATION CHECKLIST & INSTRUCTIONS Please complete the below form and submit it to your Molina Healthcare representative. Note: Using the CAQH Universal.

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All provider types can register using their Molina Provider ID. ... Your Molina Provider ID is a unique ID that is given to you by Molina Healthcare. This is a required field for registering. If you do not have your Molina Provider ID, please contact your Provider Services Representative.

Covered benefit Selected diagnostic services (including CT scans, MRIs, MRAs, PET Scans, and SPECT) require PA. Durable Medical Equipment (DME) Covered benefit Some durable medical equipment items require PA. Covered benefit PA is not required.

Limited to 25 visits per year. Members under 21 can get additional visits if authorized. Physical therapy and speech therapy visits in the home health setting are not covered through the home health program for beneficiaries age 21 and over.

Oral Surgery Medical treatments related to oral conditions such as infections, TMJ, cleft palate, and post-accident surgeries, are covered by Molina Healthcare. Oral surgery for cosmetic purposes is not covered. Prior authorization required.

Massage Therapy Not covered. Maternity Care Covered. Mental Health Covered through Community Mental Health Centers (CMHCs).

Limited to 25 visits per year. Members under 21 can get additional visits if authorized. Physical therapy and speech therapy visits in the home health setting are not covered through the home health program for beneficiaries age 21 and over. All Medicaid policy restrictions apply.

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!

You may get chiropractic services from any chiropractor who will accept your Forward Health ID Card if you are a BadgerCare Plus or Medicaid SSI member. Chriopractic services are covered by the state, not by Molina Healthcare.

Molina Healthcare offers Medicaid plans in California, Florida, Illinois, Michigan, Mississippi, Ohio, Puerto Rico, New Mexico, New York, South Carolina, Texas, Utah, Washington and Wisconsin.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232