Benefits of Using EDI
Molina supports our Providers, and as such would like to highlight the many benefits of electronic claims submission that will have direct impact on your time! EDI will help:
- Efficient information delivery
- Reduce operational costs associated with paper claims (printing, correlating, and postage)
- Increase accuracy of data
- Ensure HIPAA compliance
California Clearinghouse Information
SSI Registration Page: https://products.ssigroup.com/molinaregistrationportal/register
Phone Number
Transaction Type/Format
CMS-1500 - Professional (837P)
UB04 - Institutional (837I)
Eligibility Batch Inquiry/Response (270/271)
Claims Status Batch Inquiry/Response (276/277)
Payer ID
38333
Frequently Asked Questions
Do I need to submit a certain volume of claims to send EDI?
Which Clearinghouses are currently available to submit EDI claims to Molina?
What claims transactions are currently accepted for EDI transmission?
Where can I find more information on the HIPAA transactions?
How do I exchange the 270/271 Eligibility Inquiry?
How do I exchange the 276/277 Claim Status Inquiry/Response?
What do I do if I still have questions?
Companion Guidance Information
Molina Healthcare of California 5010
State of California *
California_State_Companion_Guide
* Please Note: This information is supplied for informational purposes only. Molina Healthcare does not guarantee the accuracy of these documents.
Contact Us
For questions about any of the following areas, please select the appropriate link:
Submitting Electronic: Claims, Referral Certification and Authorization
1-866-409-2935
Email Directly: EDI.Claims@MolinaHealthcare.com
Submitting Electronic: Encounters
1-866-409-2935
Email Directly: EDI.Encounters@MolinaHealthcare.com
Receiving 835/ERAs
1-866-409-2935
Email Directly: EDI.eraeft@MolinaHealthcare.com
EDI Web Site Links
- CMS: Centers for Medicare & Medicaid Services
- Wedi-Snip: Workgroup for Electronic Data Interchange - Strategic National Implementation Process
- WPC: Washington Publishing Company
State/Commonwealth Links
Submitting EDI Transactions
Types of EDI Transactions
Electronic Data Interchange (EDI) functionality is utilized by Molina to complete several types of ASC X12N Version 5010 transactions, including:
- Claims Submission (837 Professional and Institutional Healthcare Claims)
- Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) – (835 Healthcare Claim Payment/Advice)
- Referral Certification and Authorization (278 Healthcare Services Review - Request for Review and Response)
- Eligibility for a Health Plan (270/271 Healthcare Eligibility Benefit Inquiry and Response)
- Claims Status (276/277 Healthcare Claim Status Request and Response)
EDI Claims Submission
The easiest way to submit EDI claims to Molina Healthcare is through a Clearinghouse. You may submit the EDI claims through your own clearinghouse or use Molina’s contracted clearinghouse (see the Clearinghouse Information link for Payer ID information). If you do not have a Clearinghouse, Molina offers additional electronic claims submissions options. Log on to Molina's Provider Services Web Portal for additional information about claims submission options available to you.
270/271 Healthcare Eligibility Benefit Inquiry and Response & 276/277 Healthcare Claim Status Request and Response
Molina does not directly exchange 270/271 and 276/277 transactions. The 270/271 and 276/277 transactions are handled by Molina’s contracted clearinghouse Emdeon. The transactions may be sent directly to Emdeon or via your own clearinghouse.
EDI Forms
278 Referral Certification and Authorization Form
The 278 Request transaction is utilized to verify medical necessity for health care services; therefore, additional supporting documentation may be necessary for approval of requested services.
278 - Request for Review and Response
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