Molina Healthcare Claim Submission Requirements

Overview

Molina Healthcare requires electronic claim submission for all professional (CMS-1500) and institutional (UB-04) claims. Filing deadlines are set by each state's Medicaid contract. Submit through a clearinghouse or the Molina provider portal.

Key Requirements

  1. Electronic submission required via clearinghouse or Molina portal.
  2. Filing deadlines vary by state. Common examples: California 180 days, Texas 95 days, Ohio 365 days.
  3. Required fields: member ID, Medicaid ID, provider NPI, ICD-10, CPT/HCPCS, date of service, place of service.
  4. Include prior auth number on claim if service required PA.
  5. Secondary claims (after Medicare): file within 90 days of Medicare's EOB date.

Timeline

Day 1: Verify eligibility. Days 1-5: Submit claim electronically. Days 6-30: Molina adjudicates clean claims. Days 31-45: Payment processed. If claim rejects: correct and resubmit within the filing deadline.

Common Denials

CARC Code Reason Primary Cause Fix
CO-29 Timely filing Filed after state deadline Submit within 30 days
CO-4 Coding inconsistency Code/modifier mismatch Run edits before submission
CO-197 No prior auth Auth not obtained or not on claim Include PA number on claim line

Appeals

Appeal denied claims within the state Medicaid appeal deadline. Submit via the Molina provider portal or mail to the address on the denial letter. Include all supporting documentation.

FAQ

Does Molina accept paper claims?

Paper claims are accepted only from providers without electronic capability. Processing takes 30-45 days versus 14-21 for electronic claims. Electronic submission is strongly recommended.

What clearinghouses work with Molina?

Molina accepts claims through major clearinghouses including Availity, Change Healthcare, and Trizetto. Check the Molina provider portal for your state's approved trading partners.

How do I submit corrected claims to Molina?

Submit a replacement claim with frequency code 7 (professional) or bill type xx7 (institutional). Reference the original claim number. File within 90 days of the original remittance date.

Prevent These Denials

Altair validates claims against Molina's state-specific rules before submission.

Related Resources

This reference is current as of 2026-03-23. Payer policies change. Always verify against the payer's latest policy documentation.
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