Get WI Molina Healthcare Grievance Form

Submit Claims to Molina through your EDI clearinghouse using Payer ID ABRI1, refer to our website .MolinaHealthcare.com for additional information.

You have 60 days from the date on the Notice of Action to file an appeal with Molina Healthcare.

If you need help outside Molina If you want to talk to someone outside Molina about the problem, you can contact: For help with a grievance or appeal: HMO Enrollment Specialist at 1-800-291-2002.

Please have the Member ID, Date of Service, Tax ID, and/or Claim Number ready when calling to ensure timely assistance. Filing Limit Claims should be sent to Molina Healthcare within 90 days from the date of service.

The request for an appeal must be made no more than 60 days after you receive notice of services being denied, limited, reduced, delayed, or stopped. If you disagree with your HMO's decision about your appeal, you may request a fair hearing with the Wisconsin Division of Hearing and Appeals.

Providers should refer to their contract for specific details, or contact Molina Healthcare of Wisconsin, Inc.. Member Services at 855-326-5059.

You have 60 days from the date on the Notice of Action to file an appeal with Molina Healthcare.

Members may discontinue Molina coverage by calling Molina Member Services at 888-560-2043.