Marlien / Payer guides / Molina
Molina Healthcare
Molina Healthcare, Inc. — Molina Healthcare of Texas and Molina Healthcare of Georgia
- GA
- TX
- Medicaid (STAR, STAR+PLUS, CHIP, Georgia Families)
- Medicare Advantage
- Marketplace
- Commercial
Checked against this payer's own pages on 2026-11-04. Next review 2027-02-02.
This guide, as a document
Everything on this page, laid out to print. Use your browser's print or save-as-PDF. No email, no sign-up.
- Every line of business, with what to watch for on each.
- What we checked, and what we could not verify.
- Kept current: it is the same catalogue we work from.
It opens in a new tab. Then use your browser's print or save-as-PDF to keep a copy with your file.
The checklist is the work
This page is the map: the channel, the order it happens in, the traps, what the payer publishes about time, and what we could not verify. It is not the checklist.
We do not publish the itemised list of documents and conditions for each line of business. You will not find it on this page, and you will not find it by reading. We hand it over instead: resolved for the line you are actually filing, and written down against your own file. It is the part that takes the work, and it is the part that goes wrong when nobody has done it.
The first step is $250: we read your documents against what Molina asks for and tell you in writing what is missing, before anything is filed. It is credited in full against any engagement.
Get the Molina checklist
Tell us who you are and we will send you the whole file: the conditions that must be true before you file, and every document the payer asks for, line by line. It costs nothing and commits you to nothing.
Where you file
- How you apply
- Availity Essentials + Molina Provider Network Management portal
- The path
- Availity Essentials for registration; Molina's own Provider Network Management portal (free) for enrollment and credentialing requests. TX Medicaid adds the CVO layer.
- What access you need
- Availity org admin registers the organization; the provider works Molina's own portal.
- Who verifies
- TX: TAHP's contracted CVO (Verisys) — Molina uses the CVO for all lines of business
- Worth knowing
- Two portals, both required. The Provider Network Management portal is NOT affiliated with or integrated with Availity — discrepancies between the two are normal. Missing-info notices are issued on the Molina side, not through the CVO.
CAQH
- Required
- CAQH ProView OR the state-mandated practitioner application. For Texas Medicaid the TDI application is required on top.
- Authorise this payer
- Molina Healthcare
Lines of business
Each line is its own application, with its own checklist, its own effective date and its own contract. Filing one does not file the others. What follows is what this payer asks for, line by line.
TX Medicaid (STAR / STAR+PLUS / CHIP)TX
Adds the TDI application, the TAHP CVO layer, the TX license validity bar and the statutory expedited track. The group and the practitioner must BOTH be active with Medicaid before you can submit.
What to watch for on this line
- Check thisMolina TX: the credentialing-application requirement is CONFIRMED IN WRITING for this line — CAQH ProView accepted, or the TDI form filedWe do not file this line until Molina answers which application this line needs. This is our own bar, not a published Molina rejection rule. Call (855) 322-4080 and record the answer here with the date and who gave it. Until then, file the TDI form.
GA Medicaid (Georgia Families / 360)GA
Georgia state Medicaid enrollment is a hard prerequisite. Molina is an apparent successful health plan in the Georgia Families procurement with no existing Georgia network — these files are net-new, not roster conversions. IMPORTANT: DCH has NOT issued a Notice of Award for that procurement and has published no implementation date, so Molina cannot contract a Georgia Medicaid provider today. Treat this line as a watch item, not a filing to work now. Molina has also told providers it is starting to credential (Capitol Beat, May 2025) — a credentialing conversation is not a contract.
What to watch for on this line
- Must be trueGeorgia Medicaid: DCH has not issued a Notice of Award — Molina cannot contract a Georgia Medicaid provider yetOur own bar, not a published payer rejection rule. DCH's own update (23 April 2026) says the CMO procurement is in the protest phase pending the Notice of Award, and that no implementation timeline has been published. Molina is an apparent successful health plan with no Georgia network. Do not spend filing effort on this line until the Notice of Award is issued — and record the date and the source when it is.
Medicare Advantage (MA)Medicare Advantage
Backdating under 42 CFR 424.521 may apply. IMPORTANT: Molina's 2026 Texas Medicare Advantage Provider Manual states the TDI Standardized Credentialing Application is required for all practitioners and that Molina uses the TAHP CVO process for ALL lines of business. This line is therefore NOT a plain CAQH file — the CVO submission applies, and the TDI form is a conditional item pending the confirm gate below.
What to watch for on this line
- Check thisMolina TX: the credentialing-application requirement is CONFIRMED IN WRITING for this line — CAQH ProView accepted, or the TDI form filedWe do not file this line until Molina answers which application this line needs. This is our own bar, not a published Molina rejection rule. Call (855) 322-4080 and record the answer here with the date and who gave it. Until then, file the TDI form.
Commercial
Standard Molina track. NOT VERIFIED: Molina's Texas manuals say the TDI application and the TAHP CVO process apply to all lines of business, but no Molina TEXAS COMMERCIAL manual has been reviewed. Confirm the TDI and CVO position for this line before filing.
Marketplace
Molina is an ACA marketplace carrier in GA and TX. IMPORTANT: Molina's 2026 Texas Marketplace Provider Manual states the TDI Standardized Credentialing Application is required for all practitioners and that Molina uses the TAHP CVO process for ALL lines of business. The same manual also accepts a complete CAQH ProView application as the credentialing application — the two statements conflict, so the TDI form is a conditional item here and the confirm gate below blocks filing until Molina answers. Provider Services (855) 322-4080.
What to watch for on this line
- Check thisMolina TX: the credentialing-application requirement is CONFIRMED IN WRITING for this line — CAQH ProView accepted, or the TDI form filedWe do not file this line until Molina answers which application this line needs. This is our own bar, not a published Molina rejection rule. Call (855) 322-4080 and record the answer here with the date and who gave it. Until then, file the TDI form.
What the payer publishes about time
These are the payer's own published figures. They are not our commitment, and they are not a promise about when you can bill.
- Completeness review
- Missing-information notice issued no later than 5 business days after receipt (TX)
- Decision
- TX managed care: Molina must complete credentialing AND have the claims system recognize the provider as a Network Provider no later than 90 days after receipt of the COMPLETED application. EXPEDITED TRACK: if the provider qualifies, the claims system must be able to process claims as if Network Provider no later than 30 calendar days after receipt of a COMPLETE application, even if the credentialing review is not finished. That 30 days is a claims-processing deadline, not a decision deadline — Ins. Code §1452.104 contains no decision clock.
- Committee
- Professional Review Committee / Medical Director, plus a multi-disciplinary Credentialing Committee. TX cadence not verified — the quarterly/monthly PRC language comes from Molina's Ohio manual and does NOT apply to Texas.
- Contract
- notVerified
- What the numbers mean
- Deficiencies, not the committee, are the binding constraint. The 90-day clock starts on a COMPLETE application.
Deadlines that start a clock
These run against a filing. Miss one and the filing stops, or restarts.
Respond to the missing-information notice5 business days
counted from the date we received the deficiency notice
Attestation must be signed within 120 days of submission120 calendar days
counted from the date we submitted
Expedited credentialing — claims must process as if Network Provider30 calendar days
counted from the date we submitted
Notify material change10 calendar days
counted from the effective date
Recredentialing
- Cycle
- 36 months
- What it hangs on
- state cycle
- Worth knowing
- Notify material changes within 10 days.
The effective date
Approval is not the date. These are the markers that make a date real.
- How it is established
- TX Medicaid requires more than an approval date: Molina must complete credentialing and have the CLAIMS SYSTEM recognize the provider as a Network Provider.
- What proves it
- Claims system recognition as Network Provider + provider record
- Contract date
- This is not the same as the contract effective date. Track both.
- Worth knowing
- Track two dates: the credentialing decision and the claims-recognition date. Molina's own 90-day rule binds the second one.
Backdating: 30 daysMedicare Advantage (MA)
42 CFR 424.521(a)(1) — retrospective billing is permitted for up to 30 days before the effective date ONLY where circumstances precluded enrollment in advance of providing services, and only for services provided at the ENROLLED PRACTICE LOCATION. 90 days is available where a Presidentially-declared Stafford Act disaster precluded advance enrollment. It is a DETERMINATION, not an entitlement.
Federal rule, not confirmed in Molina's own material. MA line only.
This is a federal rule. This payer's own material does not confirm it, so we do not promise it. We tell the payer what the circumstances were and let the payer decide.
What we checked, and what we did not
Read this before relying on anything else on this page.
Channel, two-portal split, TDI application, 5-business-day missing-info notice, 120-day attestation, 90-day TX decision and claims-recognition bar, 36-month cycle, pre-enrollment login sequence, PDF-only uploads, par-date location and all four links confirmed 2026-11-02. TX committee cadence NOT verified. Re-verified 2026-11-03 by reading the 2026 TX Medicaid/CHIP, TX Marketplace and TX Medicare Advantage provider manuals in full: all three carry the identical TIC 1452 subchapter C expedited-credentialing section, the identical 'TDI application required for all Practitioners' statement, the identical 'Molina utilizes this [TAHP CVO] process for all lines of business' statement and the identical 'CAQH ProView or other state-mandated Practitioner application' wording. The TDI/CQH conflict on the non-Medicaid Texas lines is recorded, not resolved. The TX Commercial line's TDI and CVO position is NOT verified.
The payer's own pages
Where to file
- Molina Provider Network Management portal — pre-enrollment requestProviders › Work With Us › Pre-Enrollment Portal. Choose the card that matches your situation: New Provider, New Group, Existing Group Adds, New Facility.You get login credentials by email only after the pre-enrollment request is approved. No login = no portal. Documents must be PDF. CAQH is required for providers who require credentialing, but not for providers working exclusively in an inpatient or freestanding facility setting.
- Molina provider resources (state-specific)Select your state for policies, manuals and forms.Select your state for policies, manuals and forms.
- Availity Essentials — register the organizationAvaility org admin registers the organization; the provider works Molina's own portal.
- CAQH / DataSpring — authorize MolinaProView › Authorization tab › Molina Healthcare
Information and forms
- Provider Network Management Portal — FAQ (PDF, updated 2025-09-29)The best single Molina document. Covers login, rosters, missing-info responses, and where the effective date appears.
- Provider Network Management Portal — Group Enrollment guide (PDF)The step-by-step group and practitioner enrollment flow.
- Molina Texas — Medicaid/CHIP Provider Manual (PDF)States the 30-day expedited credentialing window and the 5-business-day missing-information notice.
- Molina Texas — 2026 Marketplace Provider Manual (PDF)VERIFIED 2026-11-03 (145 pp). Carries the same 'Expedited Credentialing (TIC 1452 subchapter C)' section as the Medicaid and Medicare manuals, the same TDI requirement for all practitioners, the same TAHP CVO 'all lines of business' statement, and the same 5-business-day missing-information notice.
- Molina Texas — Medicare Advantage Provider Manual 2026 (PDF)VERIFIED 2026-11-03 (169 pp). The Medicare Advantage manual, not a Marketplace manual — the two are easy to confuse. Carries the identical TIC 1452 subchapter C expedited-credentialing section, the same TDI requirement and the same TAHP CVO statement.
- Molina Texas provider resourcesState-specific policies, manuals and forms.
Who to contact
- Molina Provider Services — TexasTexas provider assistance(855) 322-4080MHTXProviderServices@MolinaHealthcare.comThe Help icon inside the Provider Network Management portal routes to the right contact for your specific issue — use that first.
- Provider relations representativeNamed contact assigned after pre-enrollmentNot published — assigned per request.
- TAHP contracted CVO (Verisys)TX Medicaid primary source verificationReached through Molina, not directly.
These are the payer's own pages. If a link stops working, tell us and we will re-check it. Links we could not verify are not published here.
Want this done for you?
Marlien assembles the core file, gets the authorisations, files every door on this page, and follows up until each payer records a decision and a written effective date. The price is written down before the work starts.
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