Molina Healthcare

Molina Healthcare

Provider guide for Molina Healthcare Medicaid plans covering credentialing, authorization, VOB, and billing across 19 states.

Quick Reference

Payer Type

Medicaid MCO

Headquarters

Long Beach, CA

Provider Portal

Open Portal

Portal Guide

View Guide →

Credentialing

CAQH ProView

Timeline

60-90 days

Coverage

19 states

Last Verified

Apr 19, 2026

Published

Mar 15, 2026

Reading Time

9 min

Covered Levels of Care

• Detoxification
• Residential Treatment (state-dependent)
• Partial Hospitalization (PHP)
• Intensive Outpatient (IOP)
• Outpatient Treatment
• Crisis Stabilization
• Medication-Assisted Treatment (MAT)

Medical Necessity Criteria

• State-Specific Medicaid Guidelines
• ASAM Criteria (for SUD level of care determinations)

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Overview

Molina Healthcare is a managed care company headquartered in Long Beach, California, that specializes in government-sponsored healthcare programs. Founded in 1980 by Dr. C. David Molina to provide quality healthcare to low-income families, the company has grown to serve approximately 5.6 million members as of 2025 across 19 states. Molina’s primary business is Medicaid managed care, though the company also operates Medicare Advantage plans and Affordable Care Act marketplace plans in select states.

Molina operates as a significant Medicaid managed care organization in each of its 19 states: Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin. Unlike payers that use different subsidiary brands in each state, Molina generally operates under the Molina Healthcare name nationwide, which simplifies brand recognition for providers, though operational processes still vary by state based on the specific Medicaid contract.

For behavioral health treatment providers, Molina represents an important Medicaid managed care payer, particularly in states with significant Medicaid populations. Because Molina’s membership skews heavily toward Medicaid, providers working with Molina should be familiar with Medicaid-specific billing, authorization, and clinical documentation requirements. Understanding the state-specific nature of Medicaid benefits is essential, as Molina’s covered services and operational processes are shaped by each state’s Medicaid program design.

Behavioral Health Coverage

Molina Healthcare’s behavioral health coverage is determined by the state Medicaid program in each state where it operates. This means that the specific services covered, levels of care authorized, and benefit limitations will differ between Molina’s state plans. Providers must reference the Molina provider manual and benefit guide specific to their state to understand exactly what is covered.

Across most Molina state plans, commonly covered behavioral health services include individual and group outpatient therapy, psychiatric evaluation and medication management, intensive outpatient programs (IOP), partial hospitalization programs (PHP), crisis intervention and stabilization, and medication-assisted treatment (MAT) for opioid and alcohol use disorders. Some states also cover peer support services, assertive community treatment, and psychosocial rehabilitation through Molina.

Residential substance use disorder treatment coverage through Molina depends on state-specific Medicaid rules. The federal IMD exclusion historically prohibited Medicaid payment for services in institutions for mental diseases (facilities with more than 16 beds). However, many states have obtained Section 1115 waivers that allow Medicaid reimbursement for residential SUD treatment in IMD facilities for short-term stays, typically up to 30 days. Check whether your state has an active 1115 SUD waiver and what facility size and length of stay limitations apply.

Medical necessity for behavioral health services is evaluated using state-specific Medicaid clinical criteria. For substance use disorder treatment, most Molina state plans reference the ASAM Criteria for determining the appropriate level of care. Mental health services are evaluated using state-adopted criteria, which may include tools such as LOCUS (Level of Care Utilization System) or state-developed guidelines. Documenting medical necessity according to the correct state-specific criteria is essential for authorization and claims payment.

Credentialing and Provider Enrollment

Molina Healthcare uses CAQH ProView as its primary credentialing data source across all states. To begin the credentialing process, ensure your facility and individual providers have current, fully attested CAQH ProView profiles. The profile should include complete information on licensure, accreditation, malpractice insurance, NPI numbers, taxonomy codes, and service locations.

Contact Molina’s provider enrollment team for your state to initiate the credentialing application. You can find state-specific contact information through Molina’s provider portal at molinahealthcare.com/providers. Molina will pull your CAQH ProView data and begin the verification process, which typically takes approximately 60 to 90 days from the receipt of a complete application, though timelines can vary. Delays can occur if your CAQH profile is incomplete, if additional documentation is required, or if there are verification issues with licenses or accreditation.

In many states, behavioral health providers must also be enrolled with the state Medicaid agency as a prerequisite to contracting with Molina or any other Medicaid MCO. State Medicaid enrollment is a separate process from Molina credentialing and can add weeks or months to the overall timeline. Begin state Medicaid enrollment early and in parallel with your Molina application where the state allows it.

Facility-level credentialing requires documentation of current state behavioral health facility licenses, accreditation from a recognized body (Joint Commission, CARF, or state equivalent), organizational NPI, professional liability insurance, Medicare and Medicaid certification where applicable, and organizational structure documents. Molina may conduct a site visit for residential facilities and other facility-based programs. Recredentialing generally occurs on a standard three-year cycle.

Verification of Benefits (VOB)

Verifying benefits for Molina Healthcare members is a necessary step before admission, even for Medicaid members who may have minimal cost-sharing. VOB confirms active Medicaid eligibility, Molina plan enrollment, assigned primary care provider, covered behavioral health services, and any applicable authorization requirements or benefit limitations.

Molina’s provider portal at molinahealthcare.com/providers offers electronic eligibility and benefits verification for most state plans. Providers can also submit standard HIPAA 270/271 eligibility transactions through their practice management system or clearinghouse. These electronic methods provide basic eligibility confirmation, plan details, and in some cases benefit-level information for behavioral health services.

For detailed behavioral health benefit verification, particularly for residential services or when electronic tools do not provide sufficient information, contact Molina’s state-specific provider services line. The phone number is listed on the member’s Molina insurance card and on the state-specific section of Molina’s provider portal. When calling, have the member’s Molina ID number, date of birth, and the specific services you plan to provide ready for the representative.

Medicaid eligibility can change monthly based on redetermination cycles, income changes, and other factors. Always verify eligibility close to or on the date of service. Also check whether the member has other insurance coverage, as Medicaid is the payer of last resort and any primary coverage must be billed first. Document all VOB details thoroughly for your records, including date, representative name, reference number, and confirmed benefits.

Prior Authorization Requirements

Molina Healthcare requires prior authorization for most facility-based behavioral health services across its state plans. Services that typically require prior authorization include residential SUD treatment, medically managed detoxification, inpatient psychiatric hospitalization, and partial hospitalization programs. Authorization requirements for intensive outpatient and outpatient services vary by state — some Molina plans require authorization for IOP while others do not.

Authorization requests can be submitted through Molina’s provider portal, by phone, or by fax. The preferred submission method varies by state, so check the Molina state-specific provider manual or contact provider services for guidance. When submitting authorization requests, include comprehensive clinical documentation covering the member’s diagnosis, presenting symptoms, substance use or psychiatric history, current functional status, previous treatment episodes, and the proposed treatment plan.

For SUD treatment, structure your clinical documentation around the ASAM Criteria dimensions: acute intoxication and withdrawal potential, biomedical conditions, emotional and behavioral conditions, readiness to change, relapse or continued use potential, and recovery environment. Clearly document why the requested level of care is the least restrictive setting that can safely and effectively address the member’s clinical needs.

Concurrent reviews for residential and inpatient services are required at regular intervals, typically approximately every 5 to 10 days depending on the level of care and state requirements, though intervals can vary. Submit updated clinical documentation demonstrating treatment progress, continued medical necessity, and discharge planning activities. If Molina denies a continued stay request, you will receive written notification with appeal rights. Request a peer-to-peer review with the Molina medical director to present additional clinical context before pursuing a formal appeal.

Claims and Billing

Molina Healthcare accepts electronic claims through standard EDI 837 transactions submitted via clearinghouses, and through the Molina provider portal in most states. Institutional claims (UB-04/837I) should be used for facility-based services, and professional claims (CMS-1500/837P) for individual provider services. Electronic claims submission is strongly preferred over paper claims and typically results in faster processing.

Billing codes, reimbursement rates, and covered service definitions follow the applicable state Medicaid fee schedule and Molina’s provider contract. Use state-specific billing codes and modifiers as required. Molina provides state-specific billing guides and code reference sheets through the provider portal in most states. Review these resources to ensure your claims are coded correctly and align with authorized services.

Timely filing deadlines for Molina Medicaid claims are governed by state Medicaid regulations and your provider agreement. Deadlines typically range from approximately 90 to 365 days from the date of service, depending on the state. Some states impose stricter timely filing requirements for Medicaid MCO claims. Verify the applicable deadline for your state and ensure claims are submitted well before the cutoff, as late-filed Medicaid claims have extremely limited recourse.

Common denial reasons include absence of required prior authorization, member not eligible on the date of service, incorrect or missing diagnosis codes, billing for non-covered services, duplicate claims, and third-party liability (TPL) issues where other insurance should have been billed first. Track your denial patterns by reason code to identify systemic billing issues. For denied claims, file corrected claims for billing errors or formal appeals for clinical denials within the timeframes specified in Molina’s provider manual for your state.

Key Contact Information

Molina operates in 19 states: AZ, CA, FL, ID, IL, KY, MA, MI, MS, NV, NM, NY, OH, SC, TX, UT, VA, WA, WI

• Provider Portal: molinahealthcare.com/providers (select your state for state-specific tools and resources)
• Provider Services: Contact the Molina state-specific provider services line listed on the member’s insurance card or the state section of the provider portal
• Credentialing: CAQH ProView for data source; contact Molina provider enrollment for your state to initiate
• Prior Authorization: Submit through the Molina provider portal, by phone, or by fax — state-specific contact information available on the provider portal
• VOB: Molina provider portal for electronic verification; state-specific provider services phone line for detailed benefit inquiries
• Claims Submission: Electronic 837 through clearinghouses or the Molina provider portal
• State Medicaid Enrollment: Required in most states as a prerequisite — contact your state Medicaid agency separately

Frequently Asked Questions

Molina Healthcare was founded in 1980 specifically to serve low-income families and individuals enrolled in government-sponsored healthcare programs. Medicaid managed care remains the core of Molina's business, though the company has expanded into Medicare Advantage and ACA marketplace plans in some states. For behavioral health providers, Molina's Medicaid focus means understanding state-specific Medicaid guidelines is essential for successful billing and authorization, as requirements can vary significantly between states.

Molina generally requires prior authorization for most facility-based behavioral health services including residential treatment, detoxification, and partial hospitalization, though specific requirements may vary by state. Authorization requests are typically submitted through Molina's provider portal, by phone, or by fax depending on the state. Clinical documentation should align with the state's medical necessity criteria, which in most states references ASAM Criteria for SUD services. Concurrent reviews are generally required for continued stays at regular intervals.

Molina operates under separate state Medicaid contracts in each of its 19 states, meaning that covered services, authorization requirements, reimbursement rates, and billing procedures can differ significantly between states. A Molina provider in California will encounter different processes than a Molina provider in Ohio. Always reference the state-specific provider manual and contact the state-specific Molina provider services team for guidance.

Credentialing with Molina Healthcare through CAQH ProView typically takes approximately 60 to 90 days from the date of a complete application, though timelines can vary. Some states may require concurrent enrollment with the state Medicaid agency, which can add time to the overall process. Ensure your CAQH profile is fully attested and that all required facility documentation including state licenses, accreditation, and liability insurance is current before applying.

Molina covers behavioral health services as defined by each state's Medicaid program. Common covered services include outpatient therapy, intensive outpatient programs, partial hospitalization, crisis stabilization, medication-assisted treatment, and in some states residential treatment. Residential SUD coverage depends on state-specific rules around the IMD exclusion and any applicable 1115 waivers. Verify covered services with Molina's state-specific plan before admitting members.

Key Billing Concepts

Revenue Cycle Resources

This guide is provided for informational purposes only and does not constitute legal, regulatory, or professional advice. Payer requirements, phone numbers, and portal URLs are subject to change. Always verify current information directly with the payer. is not affiliated with the insurance companies described on this page.

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