Key Information for Providers

Molina Healthcare of Wisconsin, Inc. adheres to Medicaid rules, with specific guidelines for physician networks and participating providers. This manual details service-specific policies, including emergency care, pathology, obstetrical billing, and various medical procedures.

Billing and Submission Guidelines

The document outlines the correct usage of claim forms such as CMS-1500 and UB-04, emphasizing the importance of accurate diagnosis coding (including ICD-10-CM), modifiers, and timely filing. It also covers electronic submission through the Molina Healthcare Provider Portal and details on handling corrected and denied claims.

Special Programs and Regulations

Information on specific programs like the Vaccines For Children Program (VFC) and guidelines for sterilization, abortion, and Mifeprex administration are included. The manual also addresses coordination of benefits, copayments, and fraud, waste, and abuse prevention.

Provider Support

For inquiries or assistance, providers can contact Molina Healthcare Member Services. The document also highlights resources for managing members with chronic conditions through Disease Management and Case Management programs.