Molina Provider Data Validation

Molina Healthcare of Michigan

Molina Healthcare completes validation of contact and demographic information of providers on a consistent basis.

We gladly appreciate your response to this brief survey.

Estimated time of survey is 5-7 minutes. Thank you in advance!

Question Title

* 1. *Provider Information

Name of Practice

TIN:

NPI:

Address:

Service Location Address:

City:

State:

Zip Code:

Phone Number:

Fax Number:

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* 2. Hours of Operation:
NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

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* 3. Do you offer after hours appointments?
NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

Yes

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* 4. Do you allow walk-in's during office hours?
NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

Yes

Other (please specify)

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* 5. Are you taking new patients?
NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

Yes

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* 6. *Our Provider Portal is know as "Availity Essentials," are you registered for Availity?

Yes

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* 7. *Do you receive the Provider Bulletin?

Yes

If you do not already receive the Provider Bulletin via email, please provide your email address if you would like to sign up for our email distribution.

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* 8. *Do you offer Telehealth Services?

Yes

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* 9. *Do you use an Electronic Health Record (EHR)

Yes

If yes, please specify?

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* 10. *Do you participate in a Health Information Exchange (HIE)?

Yes

If yes, please specify?

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* 11. *Do you use Electronic Funds Transfer (EFT)?

Yes

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* 12. *Do you utilize Electronic Data Interchange (EDI)?

Yes

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* 13. *Are you aware of the process to submit an authorization or claim reconsideration via the Availity Essentials Portal?

Yes

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* 14. *Do you know how to find information on upcoming Molina Trainings available for our provider community?

Yes

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* 15. Do you know how to find information on relevant trainings via our You Matter to Molina page on our website?

Yes

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* 16. *For PCP, BH and Specialists: Do you attest to meeting/exceeding the appointment access and availability standards located in the "Quality Improvement" chapter of the Provider Manual, posted on the Provider Website at www.MolinaHealthcare.com?

Yes

If no, please specify reason why:

Question Title

* 17. *Along with the link to this data validation survey, your Molina Provider Relations Manager sent you an affiliations roster for your review and attestation. Based on your review, please click the following statement that applies:

I have reviewed the affiliations roster and attest that all information is complete and accurate to the best of my knowledge.

I have reviewed the affiliations roster, and some information requires updates. I will access the new V12 "join our network" tab found via the link: https://pwssc-cm.molinahealthcare.com/providers/mi/medicaid/comm/Join-Molina-Healthcare-of-Michigan-Network.aspx and follow the instructions on the website to complete the required updates with Molina Healthcare.

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* 18. Do you have any other comments, questions, or concerns?

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* 19. *Contact Information

Name of Person
Completing Survey:

Title:

Phone Number:

Address:

Molina Provider Data Validation

Molina Healthcare of Michigan

Question Title

* 1. *Provider Information

Question Title

* 2. Hours of Operation:NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

Question Title

* 3. Do you offer after hours appointments?NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

Question Title

* 4. Do you allow walk-in's during office hours?NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

Question Title

* 5. Are you taking new patients?NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

Question Title

* 6. *Our Provider Portal is know as "Availity Essentials," are you registered for Availity?

Question Title

* 7. *Do you receive the Provider Bulletin?

Question Title

* 8. *Do you offer Telehealth Services?

Question Title

* 9. *Do you use an Electronic Health Record (EHR)

Question Title

* 10. *Do you participate in a Health Information Exchange (HIE)?

Question Title

* 11. *Do you use Electronic Funds Transfer (EFT)?

Question Title

* 12. *Do you utilize Electronic Data Interchange (EDI)?

Question Title

* 13. *Are you aware of the process to submit an authorization or claim reconsideration via the Availity Essentials Portal?

Question Title

* 14. *Do you know how to find information on upcoming Molina Trainings available for our provider community?

Question Title

* 15. Do you know how to find information on relevant trainings via our You Matter to Molina page on our website?

Question Title

* 16. *For PCP, BH and Specialists: Do you attest to meeting/exceeding the appointment access and availability standards located in the "Quality Improvement" chapter of the Provider Manual, posted on the Provider Website at www.MolinaHealthcare.com?

Question Title

* 17. *Along with the link to this data validation survey, your Molina Provider Relations Manager sent you an affiliations roster for your review and attestation. Based on your review, please click the following statement that applies:

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* 18. Do you have any other comments, questions, or concerns?

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* 19. *Contact Information

* 2. Hours of Operation:
NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

* 3. Do you offer after hours appointments?
NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

* 4. Do you allow walk-in's during office hours?
NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.

* 5. Are you taking new patients?
NOTE: This question is for Primary Care Providers (PCP's) only, all other provider types please skip to question 6.