Spooky Providers
A supernatural-sounding team at Molina Healthcare is responsible for offering ongoing training and making sure you don’t get caught in a compliance “web”
What is the Provider Relations Team
If a provider fails to comply with timely access to care standards, what terrifying consequence could occur to your patient satisfaction?
What are increased member complaints
This Availity feature allows providers to check the status of submitted claims without haunting the Provider Relations team.
What is Claim Status Inquiry?
In order to dodge the spooky penalties of balance billing, what must a provider remember when treating a "Medi-Medi" (dual eligible) patient?
What is Never charge them for Medicare cost-sharing
What 1960s Alfred Hitchcock movie caused people to fear showers
What is Psycho
How often should providers typically renew their credentials to stay active in the network?
What is Every 3 Years?
Which spooky set of resources should a provider visit if they need help preventing fraud, waste, and abuse?
What is the Molina Healthcare's Fraud, Waste, and Abuse portal
To avoid becoming a “locked-out ghost,” users can use this Availity feature to recover their access if they forget their login credentials.
What is Password Reset?
To check the status of a claim, providers can access this tool on Availity.
What is Claim Status Inquiry?
Which horror film features a possessed doll named Annabelle?
What is The Conjuring
How often are Provider Groups required to submit their Rosters to the health plan?
Once per quarter for Full Roster and monthly for network changes.
If a provider fails to provide care within the required timeframes, who might come knocking at your door for a “corrective action plan”?
What is The Molina Healthcare Provider Relations Team
Providers can submit authorization requests through Availity to speed up approvals and avoid getting lost in the “underworld” of paperwork.
What is Prior Authorization Submission?
If there’s an overpayment or a wrong payment, this department handles the recovery.
What is Claims Recovery?
What was the first horror film to be nominated for a Best Picture Oscar?
What is The Exorcist
A “ghost” provider is missing these crucial credentials, required every three years.
What is re-credentialing?
This list shows members assigned to each provider, so no patient is ever a “phantom.”
What is Eligibility List (E-list) Files?
When needing help, Availity users can access this section, home to training and self-service options that guide users through Availity’s spectral features.
What is Help & Training?
Claims need to be submitted with this unique payer ID to reach the “afterlife” (or processing).
What is Payer ID 38333?
In "Hocus Pocus" (1993), what were the names of the three Sanderson sisters?
Winifred, Sarah, and Mary
If a provider’s contract “disappears,” the member may continue with them for up to 12 months under this special arrangement.
What is Continuity of Care?
A "creepy" regulation that requires healthcare providers to submit accurate provider directory updates every 90 days to avoid being haunted by compliance issues?
What is SB 137 (Senate Bill 137)
When submitting a claim through the portal, what should a provider avoid to prevent it from getting lost in the haunted "denial" zone?
What is Forgetting the authorization code
Providers have up to this many days to submit claims to Molina after the date of service.
What is 180 days?
Who played the role of Sam Wheat in Ghost?
Patrick Swayze