Molina Healthcare, Inc.
April 5, 2024
Optum-Change Healthcare outage
Molina Healthcare, Inc. (Molina) is advising our providers of a critical outage of our third-party vendor, Optum-Change Healthcare (CHC), resulting in impacts to Electronic Claims Submission, Payment, and Settlement Services.
Status Update
Provider payments
As of April 4, 2024, Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. Payments are current and will continue to be processed in the order received.
835 Electronic Remittance Advice files and Explanation of Payment
835 Electronic Remittance Advice (ERA) files and Explanation of Payment (EOP) will continue to be available on providerpayments.com. These files have returned to pre-outage layouts and formats.
Electronic claims submission
As of the 4/5/24, electronic claims submissions continue to follow our alternate process, as Molina has not reconnected to CHC for any EDI clearinghouse services nor established connectivity to any of CHC's affiliate clearinghouses (iEDI/Relay) at this time.
Contact Us
Molina has established a dedicated contact center to assist providers impacted by the CHC outage. Agents can assist with claim(s) submission, emergency financial assistance requests, or other concerns related to the CHC outage. The contact center is available Monday-Friday from 5:00AM PST to 6:30PM PST.
The contact center number is (844) 548-7684.
Reminders
Claims submission
As previously communicated, providers utilizing CHC to submit claims to Molina prior to this outage may do so via our alternate established connection with SSI Claimsnet, LLC (“SSI Group”)* clearinghouse or another clearinghouse of their choice. Providers not directly utilizing CHC can and should continue utilizing their current clearinghouse for claims submission. Our Availity Essentials provider portal solution was not impacted by this outage and remains available as another option to key in claims for submission.
https://www.availity.com/availity-lifeline-self-serve-resources
https://www.availity.com/documents/learning/QSG_Atypical_Registration.pdf
During this transition, we encourage all our providers submitting paper claims to explore our electronic submission options.
Payments are current and will continue to be processed.
For those providers who have submitted electronic claims to Molina via a clearinghouse on or after 2/21/2024 and have not received acknowledgment from Molina of receipt, we advise resubmitting those claims as soon as possible. This statement does not apply to any providers submitting directly to SSI Group, UHIN, TMHP, COBA, Ohio Medicaid Enterprise System (OMES), or via our Availity portal solution.
*SSI has established connections to the following Molina Health Plans:
|
State |
Plan Name |
Electronic Payer ID |
|
AZ |
Molina Complete Care of Arizona |
MCC01 |
|
CA |
Molina Healthcare of California |
38333 |
|
FL |
Molina Healthcare of Florida |
51062 |
|
IA |
Molina Healthcare of Iowa |
MLNIA |
|
ID |
Molina Healthcare of Idaho |
61799 |
|
IL |
Molina Healthcare of Illinois |
20934 |
|
KY |
Molina Healthcare of Kentucky |
61325 |
|
MA |
Senior Whole Health of Massachusetts |
SWHMA |
|
MI |
Molina Healthcare of Michigan |
38334 |
|
MS |
Molina Healthcare of Mississippi |
77010 |
|
NE |
Molina Healthcare of Nebraska |
MLNNE |
|
NM |
Molina Healthcare of New Mexico |
09824 |
|
NV |
Molina Healthcare of Nevada |
MLNNV |
|
NY |
Molina Healthcare of New York |
16146/SWHNY |
|
OH |
Molina Healthcare of Ohio |
20149 |
|
SC |
Molina Healthcare of South Carolina |
46299 |
|
TX |
Molina Healthcare of Texas |
20554 |
|
UT |
Molina Healthcare of Utah |
SX109 (837P) |
|
VA |
Molina Complete Care of Virginia |
MCC02 |
|
WA |
Molina Healthcare of Washington |
38336 |
|
WI |
Molina Healthcare of Wisconsin |
ABRI1 |
Eligibility Verification
Molina has reestablished member eligibility verification (270/271) services using SSI Group, our alternate clearinghouse. In addition to online verification with SSI Group, eligibility verification continues to be available via the Availity Essentials portal, the Molina Contact Center and IVR. Molina’s member eligibility continues to be updated timely.
Batch member eligibility verification was not impacted by the CHC outage and has remained available for the these markets: Iowa, Mississippi, Nebraska and New York
Markets back online: Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Nevada, New Mexico, Ohio, South Carolina, Texas, Utah, Virginia, Washington, Wisconsin
We understand that the CHC outage can disrupt you and your place of practice. Molina is in regular contact with CHC, ECHO, SSI Group and Availity to help mitigate this outage, and we will continue to update our provider community regarding this situation. We appreciate your patience and understanding during this unprecedented time of disruption. Thank you for your continued partnership.
See list of additional FAQs here
All questions should be directed to Molina’s provider contact center or your local Provider Services representative. Click your state below:
Arizona | California | Florida | Idaho | Illinois | Iowa | Kentucky | Massachusetts | Michigan | Mississippi | Nebraska | Nevada | New Mexico | New York (Molina/Affinity) | New York (Senior Whole Health) | Ohio | South Carolina | Texas | Utah | Virginia | Washington |Wisconsin