About Molina Healthcare
Molina Healthcare is a managed care company focused primarily on government-sponsored health programs including Medicaid, Medicare, and ACA Marketplace plans. The company serves over 5.8 million members across 19 states and generated approximately $35.8 billion in direct written premiums in 2024. Molina has a particular strength in serving Medicaid populations.
How fast does Molina Healthcare pay?
Molina Medicaid managed care claims are subject to state-specific timely payment regulations, typically requiring clean claim payment within 14 to 30 days. Molina Marketplace plans typically process clean claims within 30 days.
Common denial and billing issues.
- Medicaid eligibility verification required at every visit
- Prior authorization required for most specialty and procedural services
- Retroactive eligibility issues common in Medicaid population
- Network adequacy limitations in some service areas
- Coordination of benefits with Medicare as primary
- Claim format errors due to Medicaid-specific billing requirements
Prior authorization requirements.
Molina requires prior authorization for a broad range of services across all product lines. Medicaid managed care authorization requirements are set by state contract and can be more extensive than commercial plans. Authorization is managed through Molina's provider portal or by phone.
How Copay works with Molina Healthcare.
Molina commercial and Marketplace claims are eligible for Copay purchase. Copay evaluates Molina claims using state-specific reimbursement data given the significant variation in Molina contract rates across its 19-state footprint.
Stop waiting on Molina Healthcare.
Eligible claims are purchased and funded the next business day.