Scheduler Form

Welcome to Molina Healthcare Peer-to-Peer Online Scheduling

The online P2P Scheduling Tool is currently only for Medicaid Medical P2P Review Requests, not Advanced Imaging, Behavioral Health, or Pharmacy.

To complete a peer-to-peer request, you will need the following information:

- Requester name and contact information
- Provider name, NPI and contact information
- Patient date of birth and authorization number
- Provider availability

(*)Indicates a required field.

*Is this a Molina Medicaid member?

Yes No

Please select one option

*Has it been more than 5 business days since you received the denial?

Yes No

Please select one option

*Have you started the appeal process for this denial?

Yes No

Please select one option

Peer-to-peer reviews must be requested within 5 business days of receiving a denial letter and before starting the appeal process. Please follow up with the appeals department at:

A&G Phone/Fax Number:
Provider Appeals- (855) 378-3643-Written Provider Appeals. They may also be submitted via the Availity
Portal. https://availity.com/molinahealthcare
Provider Disputes/ Grievances- Providers may call to generate a grievance by calling Member Services department during regular business hours (844) 862-4543.

Provider Information

*Requester First Name:

*Requester Last Name:

*Requester Phone Number:

Requester Cell Phone Number:

*Requester Email Address:

*National Provider Identification (NPI):

*NPI Category:

*Provider First Name:

*Provider Last Name:

*Provider Group Facility/Name:

*Provider Phone:

Provider Cell Phone:

*Provider Email Address:

Patient and Authorization Information

*Patient Date of Birth:

*Authorization Number:

Provider Availability

Molina Medical Directors are available Monday - Thursday 8-5pm CT and Fridays 8-11:30AM CT.

Dates/Times Available for Meeting

By submitting my information via this form, I consent to having Molina Healthcare collect my personal information. I understand and agree that my information will be used and shared in accordance with Molina Healthcare's Privacy Policy and Terms of Use.

Request for Peer-to-Peer Review Confirmation

Molina Healthcare has received your request for a peer-to-peer review. The requester will receive an email when the peer-to-peer is scheduled. This is your confirmation, you will not receive an immediate email. Please allow 2 business days for a response, please do not resubmit your request as this could cause a delay in scheduling. Please call Molina Healthcare at (855) 866 - 5462 if you have not received an email after 2 business days.

Confirmation Number

*Authorization Number

Please enter your authorization number

Welcome to Molina Healthcare Peer-to-Peer Online Scheduling

Provider Information

Patient and Authorization Information

Provider Availability

Request for Peer-to-Peer Review Confirmation

Opt-in Text Disclaimer

Information

Ease of Use

Overall Satisfaction with this Website