Eligibility
Which 2 States are you NOT given access too for eligibility verification?
Illinois and Idaho
What is cost sharing?
Sharing the cost of healthcare expenses between the member and their health plan.
What is a formulary?
A list of medication covered by a members insurance.
Who is responsible to requesting a prior authorization
Provider
What 2 numbers can be used to locate a provider?
Tax ID and NPI
What information is given to a provider when the member has a binder restriction on their account?
No information is given and ask the provider to have the member call Molina for assistance
What services do not require cost sharing for any state?
Preventative services
What database do we use to verify the status of a pharmacy PA?
CVS Caremark
If you cannot locate the provider's NPI in Molina’s system where might you look?
NPI Registry
If a provider is asking about the maximum number of visits allowed for Idaho medical services what department can you transfer them too for additional assistance?
Utilization Management
Which resources should be exhausted in order to accurately assist providers with benefit inquiries?
Benefit grid, EOC, MARC Articles and contact center partners
If an RX that does not require PA will not process, who do you contact for assistance?
Molina’s Pharmacy Department
Is a referral required for a MP member to see a specialist?
No referral needed
What is needed for Molina members to see out of network providers?
If the provider indicates that the member received a ticket # from the Marketplace exchange regarding their eligibility, where should this information be sent?
MP.Enrollments@molinahealthcare.com
What should you do if a benefit requires authorization for services?
Educate the provider on the PA process and check to see if PA was submitted.
Can a provider request a PA for a medication not located on the formulary?
Yes with Supporting Documentation
What is the standard turnaround timeframe for Marketplace authorizations in Ohio?
2 Business Days
Where do we send providers who are interested in contracting with Molina Healthcare?
DAILY DOUBLE
Who qualifies for Medicare?
Seniors, people with disabilities, and ESRD (people of all ages)
What are the types of cost share?
Copayment, coinsurance, and deductible
Do all medications through Molina have quantity limits?
Not all formulary medications have QL Requirements
What is the TAT for non-urgent authorization requests for all lines of business?
14 days
Where do we find the documents that guide us through the complete credentialing procedure?
DAILY DOUBLE
MARC