Molina

Timely filing

Claims for services provided to Molina members should be submitting within six months (180 days) of the date of service unless otherwise agreed upon in the Participating Provider Agreement. If not otherwise defined in the Participating Agreement, and/or in the case of a non-participating provider who provides covered service to Molina members, claims must be received within twelve months (180 calendar days) to be considered for processing and payment.

There are three timely filing exceptions that Molina takes under consideration:

Coordination of benefits—When an Molina member has a primary insurance, the primary insurance Explanation of Payment (EOP) or Medicare Summary Notice (MSN) is used to determine the timely filing deadline. For these claims, the time frame begins with the print date on the primary insurance EOP or MSN.
Members with retroactive eligibility—When a member becomes eligible for a DMAS Medicaid program after the date of service, but their coverage is backdated to include the date of service, the time frame for timely filing begins on the date Molina receives notification from the enrollment broker of the member’s enrollment.
Other (good cause)—Molina will consider exceptions on a case by case basis for other causes of filing delays, such as incorrect information provided by official sources.

Corrected claims, adjustments, or reconsiderations should be submitted within 180 days of the original claim paid date in order to be considered for reprocessing.

Processing and payment of claims for covered services are generally made within 30 calendar days of receipt of a clean claim. For more information on claims submission and payment, please refer to the Molina provider manual.

Q: What is the timely filing limit for appeals in Molina CA?

A: within 180 days after denial date.

You must appeal an Adverse Benefit Determination within 180 days after receiving written notice of the denial (or partial denial). You may appeal an Adverse Benefit Determination by means of written notice to us, in person, orally, or by mail, postage prepaid. Your request should include: The date of your request.

How to Submit Provider Disputes:

Method 1: Molina Provider Portal (most preferred method):

Log onto Molina’s Provider Portal at: https://provider.molinahealthcare.com/
Search and identify adjudicated claim and submit a dispute/appeal
Complete required information on the portal and upload required documents or proof to support the dispute

Method 2: Fax to (562) 499-0633

Method 3: Mail to:

Molina Healthcare of California

Attn: Provider Dispute Resolution Unit

P.O. Box 22722

Long Beach, CA 90801 Mail to:

If you are appealing for medically Necessity you can find the template in the BILLING > Letter Template> Molina Letter of Med Ness.

Articles

Molina Appeal/ Provider dispute

PDR Form

TImely Filing

Updated on: 08/14/2024 DP/ ALUM