DOCSLIB.ORG

Washingtonapple Health

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Washington Apple Health Your Medical Benefit Book MolinaHealthcare.com Non-Discrimination Notification Molina Healthcare of Washington Medicaid Molina Healthcare of Washington (Molina) complies with all Federal civil rights laws that relate to healthcare services. Molina offers healthcare services to all members without regard to race, color, national origin, age, disability, or sex. Molina does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. This includes gender identity, pregnancy and sex stereotyping. Molina also complies with applicable state laws and does not discriminate on the basis of creed, gender, gender expression or identity, sexual orientation, marital status, religion, honorably discharged veteran or military status, or the use of a trained dog guide or service animal by a person with a disability. To help you talk with us, Molina provides services free of charge: • Aids and services to people with disabilities o Skilled sign language interpreters o Written material in other formats (large print, audio, accessible electronic formats, Braille) • Language services to people who speak another language or have limited English skills o Skilled interpreters o Written material translated in your language o Material that is simply written in plain language If you need these services, contact Molina Member Services at (800) 869-7165, TTY/TTD: 711. If you believe that Molina has failed to provide these services or discriminated in another way, you can file a grievance with our Civil Rights Coordinator at (866) 606-3889, or TTY, 711. Mail your complaint to: Civil Rights Coordinator 200 Oceangate Long Beach, CA 90802 You can also email your complaint to [email protected]. Or, fax your complaint to (800) 816-3778. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. You can mail it to: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 You can also send it to a website through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf. If you need help, call 1-800-368-1019; TTY 800-537-7697. Language Access If you, or someone you’re helping, have questions about Molina Medicaid, you have the right to get help and information in your language at no cost. To talk to an interpreter, call (800) 869-7165 (TTY 711). Amharic እርስዎ፣ወይምእርስዎየሚያግዙትግለሰብ፣ስለMolina Medicaid ጥያቄካላችሁ፣ያለምንምክፍያበቋንቋዎእርዳታና መረጃየማግኘትመብትአላችሁ።ከአስተርጓሚጋርለመነጋገር፣(800) 869-7165 (TTY 711) ይደውሉ። إن كان لديك أو لدى شخص تساعده أسئلة بخصوص Molina Medicaid, فلديك الحق في الحصول على المساعدة والمعلومات Arabic الضرورية بلغتك من دون اية تكلفة. للتحدث مع مترجم اتصل بـ (TTY 711) 869-7165 (800). Chinese 如果您，或是您正在協助的對象，有關於[插入SBM項目的名稱Molina Mediaid 方面的 問題，您有權利免費以您的母語得到幫助和訊息。洽詢一位翻譯員，請撥電話[在此插入數字1- (800) 869-7165 (TTY 711)。 Cushite- Isin yookan namni biraa isin deeggartan Molina Medicaid irratti gaaffii yo qabaattan, kaffaltii irraa Oromo bilisa haala ta’een afaan keessaniin odeeffannoo argachuu fi deeggarsa argachuuf mirga ni qabdu. Nama isiniif ibsu argachuuf, lakkoofsa bilbilaa (800) 869-7165 (TTY 711) tiin bilbilaa. German Falls Sie oder jemand, dem Sie helfen, Fragen zum Molina Medicaid haben, haben Sie das Recht, kostenlose Hilfe und Informationen in Ihrer Sprache zu erhalten. Um mit einem Dolmetscher zu sprechen, rufen Sie bitte die Nummer (800) 869-7165 (TTY 711)an. Japanese ご本人様、またはお客様の身の回りの方でも、Molina Medicaid についてご質問がございま したら、ご希望の言語でサポートを受けたり、情報を入手したりすることができます。料金 はかかりません。通訳とお話される場合、(800) 869-7165 (TTY 711) までお電話ください。 Korean 만약 귀하 또는 귀하가 돕고 있는 어떤 사람이Molina Medicaid 에 관해서 질문이 있다면 귀하는 그러한 도움과 정보를 귀하의 언어로 비용 부담없이 얻을 수 있는 권리가 있습니다. 그렇게 통역사와 얘기하기 위해서는(800) 869-7165 (TTY 711)로 전화하십시오. Laotian ຖ້ າທ່ ານ, ຫ ຄົ ນ ່ທທ່ ານກໍ າລັ ງຊ່ ວຍເຫ ອ, ມໍຄາຖາມກ່ ຽວກັ ບ Molina Medicaid, ທ່ ານ ມິສດ ່ທຈະໄດ້ ຮັ ບການຊ່ ວຍເຫ ອແລະໍຂ້ ມູ ນຂ່ າວສານ ່ທເປັ ນພາສາຂອງທ່ ານໍ່ບ ມຄ່ າໃຊ້ ຈ່ າຍ. ການໂອ້ ລົ ມກັ ບນາຍພາສາ, ໃຫ້ ໂທຫາ (800) 869-7165 (TTY 711). Cambodian- Molina Medicaid , Mon-Khmer 叒រសិនបរើ诒នក ឬនរ㮶ម្ននក់ដែល诒នកកំពុងដែជួយ ម្ននសំណួរ诒ំពី បេ 诒នកម្ននសិេធិេេួលជំនួយនិងព័ែ៌ម្នន បៅកនុង徶羶 ររស់诒នក បោយមិន诒ស់叒ាក់ ។ បែើមបីនិ架យᾶមួយ诒នករកដ叒រ សូម (800) 869-7165 (TTY 711)។ Punjabi ਜੇ ਤੁਹਾਨੰ ੂ , ਜ␀ ਤੁਸੀ ਿੂਜਸ ਦੀ ਮਦਦ ਕਰ ਰਹੇ ਹੋ , Molina Medicaid ਕੋਈ ਸਵਾਲ ਹੈ ਤ␀, ਤੁਹਾਨੰ ੂ ਿੂਬਨਾ ਿੂਕਸ ੂੇ ਕੀਮਤ 'ਤੇ ਣੀ ਭਾ ਿ ੂ ਵੱ ਚ ਮਦਦ ਅਤੇ ਜਾਣਕਾਰੀ ਪ␀ੂਾਪਤ ਕਰਨ ਦਾ ਿਅਧਕਾਰ ਹੈ . ਦੁਭਾੀ ਨਾਲ ਗੱ ਲ ਕਰਨ ਲਈ, (800) 869-7165 (TTY 711)ਤੇ ਕਾਲ ਕਰੋ . Russian Если у вас или лица, которому вы помогаете, имеются вопросы по поводу Molina Medicaid, то вы имеете право на бесплатное получение помощи и информации на вашем языке. Для разговора с переводчиком позвоните по телефону (800) 869-7165 (TTY 711). Spanish Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Molina Healthcare tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al (800) 869-7165 (TTY 711). Tagalog Kung ikaw, o ang iyong tinutulangan, ay may mga katanungan tungkol sa Molina Medicaid, may karapatan ka na makakuha ng tulong at impormasyon sa iyong wika ng walang gastos. Upang makausap ang isang tagasalin, tumawag sa (800) 869-7165 (TTY 711). Ukrainian Якщо у Вас чи у когось, хто отримує Вашу допомогу, виникають питання Molina Medicaid, у Вас є право отримати безкоштовну допомогу та інформацію на Вашій рідній мові. Щоб зв’язатись з перекладачем, задзвоніть на (800) 869-7165 (TTY 711). Vietnamese Nếu quý vị, hay người mà quý vị đang giúp đỡ, có câu hỏi về Molina Medicaid, quý vị sẽ có quyền được giúp và có thêm thông tin bằng ngôn ngữ của mình miễn phí. Để nói chuyện với một thông dịch viên, xin gọi (800) 869-7165 (TTY 711). WASHINGTON APPLE HEALTH YOUR MEDICAL BENEFIT BOOK 2017 Table of Contents Welcome to Washington Apple Health from Molina Healthcare of Washington ........................... 1 Important contact information .............................................................................................................. 1 How to use this book ............................................................................................................................... 2 The plan, our providers, and you............................................................................................................ 2 How to choose your Primary Care Provider (PCP) ............................................................................ 4 You will need two cards to access services ............................................................................................ 4 Your Molina Healthcare ID card ............................................................................................................ 4 Your ProviderOne services card ............................................................................................................. 4 Changing health plans ............................................................................................................................. 5 How to get health care ............................................................................................................................. 5 How to get specialty care and referrals .................................................................................................. 6 Services from Molina Healthcare WITHOUT a referral .................................................................... 6 Payment for health care .......................................................................................................................... 7 How to get care in an emergency or when you are away from home ................................................ 7 Getting care after hours ........................................................................................................................... 7 A health plan provider will see you ........................................................................................................ 8 You must go to a Molina Healthcare provider, pharmacy, or hospital .............................................. 8 Behavioral health services ....................................................................................................................... 8 Prescriptions ............................................................................................................................................. 9 Medical equipment or medical supplies ................................................................................................ 9 Special health care needs or long-term illness ...................................................................................... 9 Long-term care services ........................................................................................................................... 9 Health care services for children ............................................................................................................ 9 Benefits covered by Molina Healthcare ............................................................................................... 10 Additional services from Molina Healthcare ...................................................................................... 15 Fraud, Waste and Abuse ........................................................................................................................ 18 Services covered outside of Molina Healthcare .................................................................................
Recommended publications
  • Molina Medicaid Solutions: CMS Certifications

    Molina Medicaid Solutions: CMS Certifications

    Molina Medicaid Solutions: CMS Certifications High Quality Claims Management Molina Medicaid Solutions is committed to quality care and provides Medicaid health care information management services to help our state government partners meet the diverse needs of more than three million Medicaid beneficiaries. Molina Medicaid Solutions has fiscal agent contracts for five states across the United States. All have received full federal certification from the Centers for Medicare and Medicaid Services (CMS), most recently Idaho and Maine. Molina’s industry-leading solution, Health PAS, is the Medicaid Management Information Systems (MMIS) for Idaho and Maine and was certified using the latest certification toolkit. HealthPASHealthPASHealthPAS Molina Medicaid Molina Medicaid Molina Medicaid Solutions Solutions Solutions of Idaho of West Virginia of Maine Molina Medicaid Solutions of New Jersey HealthHealthPAS PAS Molina Medicaid Solutions CMS Certified of Louisiana 26600MMS0712 Molina Medicaid Solutions Profile Molina Healthcare is the only health care company providing business processing and information technology administrative services to Medicaid agencies. Through its wholly-owned subsidiary, Molina Medicaid Solutions, Molina’s Medicaid management information systems’ design, development, implementation, and operation expertise provide the technological foundation needed by state agencies to meet current and future Medicaid Information Technology Architecture (MITA) business process and regulatory health care requirements. Molina Medicaid
  • Molina Healthcare of Utah: Quick Reference Contact List

    Molina Healthcare of Utah: Quick Reference Contact List

    Molina Healthcare of Utah: Quick Reference Contact List Take care of your needs with the Molina Provider Portal 24/7. Molina Provider Portal (Click Here) Claims Member Information Claim status Receive Notifications Covered services Missing HEDIS services Correct or void claims Submit claims Eligibility status Product Benefits Download claim reports Make changes to your group Health records Rosters of assigned members Do you still need help? Give our Provider Contact Center a call. Molina Medicaid, Medicaid Expansion, CHIP, Marketplace (855) 322-4081 Molina Medicare Complete Care and Choice Care (866) 449-6817 What the Provider Contact Center can help with: Benefit and Eligibility questions Authorization inquiries Participating Provider Network inquiries Claim status and inquiries PCP assignment updates File a Grievance or Appeal Need a Prior Authorization for services? Molina Medicaid, Medicaid Expansion, CHIP Prior Authorization Guide (Click Here) Molina Medicare Complete Care and Choice Care Prior Authorization Guide (Click Here) Molina Marketplace Prior Authorization Guide (Click Here) Need to file an appeal? Molina Appeal Form (Click Here) Page | 1 Current June 22, 2021 Medicare – Molina Medicare Complete Care and Molina Medicare Choice Care Contracted Medicare Timeline to File Appeal 120 Calendar Days Fax (877) 682-2218 Molina Healthcare of Idaho, Inc. Attn: Provider Appeals Address 7050 Union Park Center Suite 200 Midvale, UT 84047 Non-Contracted Medicare Timeline to File Appeal 60 Calendar Days Fax (562) 499-0610 Molina Healthcare, Attn: Non-Contracted Provider Appeals Address P.O. Box 22816 Long Beach, CA 90801-9977 Utah Medicaid/CHIP Timeline to File Appeal 60 Calendar Days Fax (877) 682-2218 Molina Healthcare of Utah, Inc.
  • HMO SNP 2021 | Evidence of Coverage

    HMO SNP 2021 | Evidence of Coverage

    Molina Medicare Complete Care Molina Medicare Complete Care HMO SNP 2021 | Evidence of Coverage Ohio H8176-002 Serving Adams, Auglaize, Brown, Butler, Carroll, Champaign, Clark, Clermont, Clinton, Columbiana, Coshocton, Crawford, Cuyahoga, Darke, Defiance, Delaware, Erie, Fairfield, Fayette, Franklin, Fulton, Gallia, Geauga, Greene, Guernsey, Hamilton, Hardin, Harrison, Henry, Highland, Hocking, Holmes, Jackson, Lake, Lawrence, Licking, Logan, Lorain, Lucas, Madison, Mahoning, Marion, Medina, Meigs, Mercer, Miami, Monroe, Montgomery, Morgan, Morrow, Noble, Ottawa, Paulding, Perry, Pickaway, Pike, Portage, Preble, Putnam, Shelby, Stark, Summit, Trumbull, Union, Van Wert, Vinton, Warren, Washington, Williams, Wood, and Wyandot counties January 1 – December 31, 2021 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Molina Medicare Complete Care (HMO SNP) This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. It explains how to get coverage for the health care services and prescription drugs you need. This is an important legal document. Please keep it in a safe place. This plan, Molina Medicare Complete Care (HMO SNP), is offered by Molina Medicare of Ohio (Molina Healthcare of South Carolina) (When this Evidence of Coverage says “we,” “us,” or “our,” it means Molina Medicare of Ohio (Molina Healthcare of South Carolina). When it says “plan” or “our plan,” it means Molina Medicare Complete Care (HMO SNP).) This document is available for free in Spanish. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (866) 472-4584 (TTY: 711). Please contact our Member Services number at (866) 472-4584 for additional information.
  • Molina Healthcare Caring for Families for 35 Years

    Molina Healthcare Caring for Families for 35 Years

    Molina Healthcare Caring for families for 35 years Maternal Health Program The Molina Story Three Decades of Delivering Access to Quality Care Molina Healthcare’s history and member- focused approach began with the vision of Dr. C. David Molina, an emergency department physician who saw people in need and opened a community clinic where caring for people was more important than their ability to pay. Today Molina Healthcare serves the diverse needs of more than 4 million plan members and beneficiaries across the United States through government-funded programs. Molina Healthcare provides NCQA-accredited care and services that focus on promoting health, wellness and improved patient outcomes. While the company continues to grow, we always put people first. We treat everyone like family, just as Dr. Molina did – making Molina Healthcare your extended family. The Molina Mission Our Vision We envision a future where everyone receives quality health care. Our Mission To provide quality health care to persons receiving government assistance. Core Values Caring Enthusiastic Respectful Focused Thrifty Accountable Feedback One Molina Molina Healthcare of Ohio Snapshot Health Plan Facts Medicaid MyCare Ohio • 336,000 members Medicare Marketplace • 1,000 employees Ashtabula Lake • 3 offices across Ohio Geauga Lucas Cuyahoga Trumbull Ottawa Fulton Erie Lorain Portage Williams Sandusky Summit Mahoning Wood Henry Huron Medina Defiance Seneca Columbiana Provider Network Stark Hancock Ashland Wayne Paulding Putnam Crawford Wyandot Richland Carroll Jefferson
  • Ohio Provider Contract Request Form

    Ohio Provider Contract Request Form

    Ohio Provider Contract Request Form If you are not currently a contracted provider with Molina Healthcare of Ohio and you are interested in joining our network of quality health care providers, or if you wish to add a line of business to your existing contract, please email this completed form to [email protected] or fax to the attention of Provider Contracts at (866) 384-1226. Please note: In order for providers to contract with a Medicaid managed care plan, the Ohio Department of Medicaid requires all providers to be enrolled with Ohio Medicaid at both the practice/facility and individual provider levels, as applicable. If you are an individual provider joining a contracted practice, please do not complete or submit this form. Please complete and submit a Provider Information Update Form (PIF). Click here to find the form, or go to www.MolinaHealthcare.com/OhioProviders, click on the “Forms” tab and look under the “Contracted Providers Making Changes” section. Practice/Facility Name: Practice/Facility Ohio Medicaid ID: Practice/Facility Tax ID Number: Mailing Address: City: State: Zip: Primary Office Location (if different from mailing address): Specialty/Provider Type: Person Completing Form: County: Phone: Email Address: If you are a professional practice that employs multiple providers, please provide information for all individual providers in the table below or on a separate sheet (excludes ancillary providers): Provider Individual Individual Individual Provider Name Individual NPI Type/Specialty Medicaid ID Medicare ID Are all providers employed by the group? ☐Yes or ☐No If NO, please be advised that separate Provider Services Agreements will need to be completed for non-employed providers.
  • Molina Healthcare of Washington Serving Since 1985*

    Molina Healthcare of Washington Serving Since 1985*

    Molina Healthcare of Washington Serving since 1985* Molina Healthcare of Washington Key Health Plan Facts Molina Healthcare of Washington is a managed care organization that arranges for the delivery of health care services to low-income Membership: 403,000** families and individuals who are eligible for government-sponsored programs in the state of Washington. Employees: 484 Lines of Business • Medicaid Whatcom Pend Oreille - Apple Health (AH) San Juan Okanogan Ferry Skagit Stevens - Washington Medical Integration Island Clallam Partnership (WMIP) Snohomish Chelan Jeerson Douglas • Medicare Lincoln Spokane Kitsap King - Molina Medicare Options Grays Mason King Harbor Kittitas Grant Plus (HMO SNP) Pierce Adams Whitman urston • Health Benefit Exchange - Pacic Lewis Franklin Gareld Marketplace (MP) Yakima Columbia Wahkiakum Cowlitz Asotin Skamania Benton Walla Walla Klickitat Provider Network (Medicaid) Clark • Molina Medical primary care offices - 1 • Primary care physicians - 4,269 Service Areas: • Specialist physicians - 9,725 AH AH, Medicare • Ancillary services - 7,677 • Hospitals - 97 Molina Medical AH, WMIP, Medicare (Primary Care Offices) AH, MP, Medicare Recognition Ranked #1 Medicaid health plan in Washington state and #69 Health Plan Leadership Medicaid health plan in US*** Ann Koontz, Interim Plan President Robert Herr, MD, Chief Medical Officer Molina Healthcare Corporate Facts Recent News: Total Membership: 1,931,000** • October 2013 Recognized Seven Unsung Health Plans: CA, FL, IL, MI, NM, OH, SC, TX, UT, WA, WI Heroes From Across the State with Fifth Annual • More than three decades of service and experience Community Champions Awards and Grants • FORTUNE 500 Company • September 2013 Molina Healthcare of Washington Selected to Participate in the Washington Health Benefit Exchange *QualMed welcomed first members in 1985, Molina purchased QualMed in 2000 (Marketplace).
  • Texas Standard Prior Authorization Request Form for Health Care Services

    Texas Standard Prior Authorization Request Form for Health Care Services

    Texas Standard Prior Authorization Request Form for Health Care Services NOFR001 | 0415 Texas Department of Insurance Please read all instructions below before completing this form. Please send this request to the issuer from whom you are seeking authorization. Do not send this form to the Texas Department of Insurance, the Texas Health and Human Services Commission, or the patient’s or subscriber’s employer. Beginning September 1, 2015, health benefit plan issuers must accept the Texas Standard Prior Authorization Request Form for Health Care Services if the plan requires prior authorization of a health care service. In addition to commercial issuers, the following public issuers must accept the form: Medicaid, the Medicaid managed care program, the Children’s Health Insurance Program (CHIP), and plans covering employees of the state of Texas, most school districts, and The University of Texas and Texas A&M Systems. Intended Use: Use this form to request authorization by fax or mail when an issuer requires prior authorization of a health care service. An Issuer may also provide an electronic version of this form on its website that you can complete and submit electronically, through the issuer’s portal, to request prior authorization of a health care service. Do not use this form to: 1) request an appeal; 2) confirm eligibility; 3) verify coverage; 4) request a guarantee of payment; 5) ask whether a service requires prior authorization; 6) request prior authorization of a prescription drug; or 7) request a referral to an out of network physician, facility or other health care provider. Additional Information and Instructions: Section I – Submission: An issuer may have already entered this information on the copy of this form posted on its website.
  • Welcome to the Molina Family

    Welcome to the Molina Family

    Welcome to the Molina family. Member Handbook Molina Healthcare of Illinois Integrated Care Program Issued October 2013 Important Molina Healthcare Phone Numbers Member Services (855) 766-5462 TTY/Illinois Relay Service: 711 24-Hour Nurse Advice Line English: (888) 275-8750 Español: (866) 648-3537 TTY: (866) 735-2929 24-Hour Behavioral Health Crisis Line English: (888) 275-8750 Español: (866) 648-3537 TTY: (866) 735-2929 Transportation (877) 917-8164 TTY/Illinois Relay Service: 711 Care Coordination (855) 766-5462 TTY/Illinois Relay Service: 711 1 Table of Contents Welcome to Molina Healthcare! .......................................... 4 Language Help ....................................................................................4 Interpretive Services ..........................................................................4 Member Services ................................................................. 5 Identification (ID) Cards .................................................... 8 Provider Directory .............................................................. 9 New Member Information .................................................. 10 Transition of Care ..............................................................................10 Waiver Programs ................................................................................11 24-Hour Advice Lines .......................................................... 11 Your Medical Home ............................................................. 12 Choosing a Primary Care Provider
  • Abernathy V. Molina Healthcare, Inc

    Abernathy V. Molina Healthcare, Inc

    Case 1:20-cv-00042-DBP Document 2 Filed 04/23/20 Page 1 of 16 Elizabeth M. Peck (USB 6304) PECK-LAW, Employment & Civil Rights 111 N. Market St., Ste. 300 San Jose, California 95113 408-478-3555 [email protected] Attorneys for Plaintiffs IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF UTAH CENTRAL DIVISION CINDY ABERNATHY, individually COLLECTIVE ACTION and on behalf of all persons similarly COMPLAINT situated, JURY DEMANDED Plaintiff, Civil No.: 1:20-cv-00042-DBP v. Mag. Judge Dustin B. Pead MOLINA HEALTHCARE, INC., Defendant. COLLECTIVE ACTION COMPLAINT Plaintiff Cindy Abernathy (“Plaintiff” or “Abernathy”), on behalf of herself and all others similarly situated, by and through her attorneys, brings this lawsuit against Molina Healthcare, Inc. (“Molina” or “Defendant”), seeking all available remedies under the Fair Labor Standards Act, 29 U.S.C. §§ 201, et seq. (“FLSA”). Case 1:20-cv-00042-DBP Document 2 Filed 04/23/20 Page 2 of 16 The foregoing allegations are made on personal knowledge as to Plaintiff’s own conduct and are made on information and belief as to the acts of others. INTRODUCTION 1. Molina is a Managed Care Organization (“MCO”) that reaps hundreds of millions of dollars per year in incentive bonuses paid by the Centers for Medicare & Medicaid Services (“CMS”). These bonuses are paid based on material submitted to CMS that reflects certain objective indicators of “quality” healthcare called Healthcare Effectiveness Data and Information Set (“HEDIS”) measures. Molina relies on a workforce comprised largely of HEDIS Reviewers and Abstractors (collectively, “HEDIS Reviewers”) who regularly work upwards of forty (40) or fifty (50) hours per week to prepare the material ultimately submitted to CMS to determine these bonus payments.
  • Infosys Helps Molina Accelerate Time-To-Market of Government-Sponsored Health Plan for Puerto Rico

    Infosys Helps Molina Accelerate Time-To-Market of Government-Sponsored Health Plan for Puerto Rico

    CASE STUDY INFOSYS HELPS MOLINA ACCELERATE TIME-TO-MARKET OF GOVERNMENT- SPONSORED HEALTH PLAN FOR PUERTO RICO Abstract Molina Healthcare Inc., a leading, managed-care organization, partners with Infosys to set up a health plan in Puerto Rico, within a record span of four months. About Molina Molina Healthcare Inc., is a Fortune 500 company, based in Long Beach, California, operating health plans, clinics, and health information management solutions. It was established in 1980, when, as an emergency room physician, C. David Molina, MD, noticed that low-income, uninsured, or non-English-speaking patients were coming to the emergency room, when in need of general health- care services. Without family doctors, they did not always receive the right care and information. These underserved Business need families deserved better and Dr. Molina • The scale of the program, the number set out to do something about it. In December 2014, Molina Healthcare of moving parts in it, and the agility Inc., entered into a Medicaid contract it warranted He opened a clinic in Wilmington, with the Puerto Rico Health Insurance California, to provide low-income • Evolving requirements throughout the Administration, with an operational start individuals and families a place where program life cycle added complexity date of April 1st, 2015. This was a significant they could receive personalized health to the mix and strategic win for Molina care, and two more clinics were opened Go-to-market in a record time of as it brought in 350,000 members right • in that same year. Today, Molina’s health four months, from scratch, posed a from the get-go, along with a billion plans and clinics serve patients across the huge challenge dollars in revenue.
  • Molina Healthcare of Puerto Rico Provider Orientation – April, 2015 Provider Orientation

    Molina Healthcare of Puerto Rico Provider Orientation – April, 2015 Provider Orientation

    Molina Healthcare of Puerto Rico Provider Orientation – April, 2015 Provider Orientation The goal of this provider orientation is to ensure that you as a provider have a good understanding of Molina Healthcare of Puerto Rico, (“MHPR”) our policies and procedures, and the resources/tools available to assist you and your staff in our efforts in delivering high quality services to our members. We appreciate and value your participation in Molina’s provider network and look forward to our partnership to deliver quality, patient-centered, culturally sensitive, accessible and integrated healthcare services to our members. 2 Our Story & Who We Are In 1980, the late Dr. C. David Molina, founded Molina Healthcare with a single clinic and a commitment to provide quality healthcare to those most in need and least able to afford it. This commitment to providing access to quality care continues to be Mission Statement our mission today, just as it has been for the last 34 years. Our mission is to provide quality health services to financially vulnerable families and individuals covered by government programs. Vision Statement Molina Healthcare is an innovative national health care leader, providing quality care and accessible services in an efficient and caring manner. Core Values We strive to be an exemplary organization: 1. We care about the people we serve and advocate on their behalf. 2. We provide quality service and remove barriers to health services. 3. We are health care innovators and embrace change quickly. 4. We respect each other and value ethical business practices. 5. We are careful in the management of our financial resources and serve as prudent stewards of the public’s funds.
  • Molina Healthcare of Wisconsin, Inc

    Molina Healthcare of Wisconsin, Inc

    Report of the Examination of Molina Healthcare of Wisconsin, Inc. Milwaukee, Wisconsin As of December 31, 2018 TABLE OF CONTENTS Page I. INTRODUCTION ................................................................................................................ 1 II. HISTORY AND PLAN OF OPERATION ............................................................................ 3 III. MANAGEMENT AND CONTROL ....................................................................................... 7 IV. AFFILIATED COMPANIES ................................................................................................. 9 V. REINSURANCE ................................................................................................................ 12 VI. FINANCIAL DATA ............................................................................................................ 13 VII. SUMMARY OF EXAMINATION RESULTS ...................................................................... 21 VIII. CONCLUSION .................................................................................................................. 23 IX. SUMMARY OF COMMENTS AND RECOMMENDATIONS ............................................ 24 X. ACKNOWLEDGMENT...................................................................................................... 25 XI. SUBSEQUENT EVENTS .................................................................................................. 26 State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE 125 South Webster Street • P.O.