Molina Healthcare Inc · NYSE:MOH
Molina Healthcare — Investor Presentation (February 2025)
68 slides from Molina Healthcare's investor presentation, February 2025
Slide 1: You Matter to Molina: Introduction to Telehealth
You Matter to Molina: Introduction to Telehealth 2025 | Molina Healthcare of Ohio, Inc. MHO-PROV-0174 0225
Slide 2: Agenda
• Provider Resources • Availity Essentials Portal • Introduction to Telehealth • Getting Started with Telehealth • Telehealth Provisions AGENDA • Provider Responsibilities • Telehealth Member Eligibility & Benefits • Telehealth Claims & Billing • Telehealth Provider Billing Guidelines: Specialty Spe
Slide 3: Provider Resources
Provider Resources
Slide 4: Provider Relations
Provider Relations Satisfaction Communication Technology • Provider Relations • Provider Bulletin and • 24-hour Provider Portal Representatives and Provider Newsletters • Online Prior Authorization (PA) Engagement Teams • Online Provider and Claim Dispute Submission • Annual Assessment of Manuals •
Slide 5: Provider Website
Provider Website Molina has a Provider Website for each line of business, available under the Health Care Professionals drop-down menu. Find the Provider Website at MolinaHealthcare.com. 5
Slide 6: Provider Online Resources
Provider Online Resources Molina’s Provider Website has a variety of online resources: You Matter to Molina Page and a Provider Dental Claims Contact Claims Payment Systemic Errors Manual Manual Information Information (CPSE) Page Provider Online Availity Essentials Portal Directory Member Rights an
Slide 7: Provider Manual Highlights
Provider Manual Highlights Provider Manuals are specific to each line of business. Each Provider Manual is customarily updated annually but may be updated more frequently. Information in the Provider Manual includes: Benefits and Covered Services Member Rights and Responsibilities Claims and Compens
Slide 8: Provider Bulletin
Provider Bulletin The Provider Bulletin includes: • Prior authorization changes • Training opportunities • Updates to the Availity Essentials Portal To join our distribution list, visit our Provider • You Matter to Molina Corner Website at MolinaHealthcare.com and under the • Changes in policies tha
Slide 9: Molina Provider Online Directory
To find a Molina provider, click Molina Provider Online Directory “Find a Doctor or Pharmacy” The Molina Provider Online Directory offers enhanced search functionality so information is available quickly and easily. Providers are encouraged to use the Provider Online Directory linked on our Provider
Slide 10: ODM Provider Online Directory and OH|ID
ODM Provider Online Directory and OH|ID As of Oct. 1, 2022, the Ohio Department of Medicaid (ODM) launched the Provider Network Management (PNM) module to develop a comprehensive provider directory at the state level. View the ODM Quick Reference Guides to learn more. Important! Medicaid providers a
Slide 11: Provider Data Accuracy
Provider Data Accuracy Maintaining an accurate and current Provider Directory is a state and federal regulatory requirement, as well as a National Committee for Quality Assurance (NCQA)-required element. Medicaid and MyCare Ohio: On Oct. 1, 2022, ODM migrated to the new PNM system for provider infor
Slide 12: Molina ID Cards
Molina ID Cards Providers are encouraged to review the most up-to-date version of the Molina Member ID Cards available in our Provider Manuals at MolinaHealthcare.com on the “Manual” page. Medicaid Member Cards MyCare Ohio Member Cards Medicare Member Card Marketplace Member Card 12
Slide 13: Provider Responsibilities
Provider Responsibilities Molina expects our contracted providers will respect the privacy of Molina members (including Molina members who are not patients of the provider) and comply with all applicable laws and regulations regarding the privacy of patient and member Protected Health Information (P
Slide 14: You Matter to Molina
You Matter to Molina At Molina of Ohio, our providers matter! Our “You Matter to Molina” program connects us directly to our entire network of providers as we support their efforts to delivery high-quality and efficient health care for Molina members. • The program gives providers access to monthly
Slide 15: Availity Essentials Portal
Availity Essentials Portal
Slide 16: Availity Essentials (Availity) Provider Portal
Availity Essentials (Availity) Provider Portal Register for the Availity Essentials Portal at availity.com/provider-portal-registration and select your organization type. Log into the Availity Essentials Portal at: apps.availity.com/availity/web/public.elegant.login. 16
Slide 17: Availity Essentials Provider Portal
Availity Essentials Provider Portal Once registered providers will have access to the Availity Essentials Portal training by following these steps: In the Availity Learning Center (ALC) that opens in a new browser tab, search the catalog and enroll Select Help & for this title: Availity Overview for
Slide 18: Availity Essentials Provider Portal
Availity Essentials Provider Portal The Availity Essentials Provider Portal is secure and available 24 hours a day, seven days a week. Self-service Provider Portal options include: Online Claims Corrected Claim Status Claims Submission Inquiry Member Eligibility Secure Verification and Benefits Mess
Slide 19: Introduction to Telehealth
Introduction to Telehealth
Slide 20: What is Telehealth?
What is Telehealth? Telehealth, or telemedicine, is the direct delivery of health care services to a patient related to the diagnosis, treatment and management of a condition. Telehealth is the interaction with a patient via interactive, real-time electronic communication that includes both audio an
Slide 21: The Difference Between Telehealth and Telemedicine
The Difference Between Telehealth and Telemedicine According to the Federal Communications Commission (FCC): Telemedicine can be defined as using telecommunications technologies to support the delivery of all kinds of medical, diagnostic and treatment-related services usually by doctors. Telehealth
Slide 22: Some Benefits of Implementing Telehealth
Some Benefits of Implementing Telehealth Potential for Easier shorter waiting access to care for time from request to Extended prenatal members with consultation, diagnosis care to members in physical limitations and management rural areas and transportation plan for hardships patients More flexibil
Slide 23: Getting Started with Telehealth
Getting Started with Telehealth
Slide 24: Factors to Consider When Preparing to Offer Telehealth Visits
Factors to Consider When Preparing to Offer Telehealth Visits in Your Practice • Staffing: Will you need a telehealth • Meeting Patient Needs: Will your coordinator? How will staff roles patients require special change? How will you train your current accommodations? Will your patients health care t
Slide 25: Finding a Telehealth Vendor
Finding a Telehealth Vendor If your organization requires assistance in setting up a telehealth option for the first time, many resources are available online to help you find assistance in finding a technology vendor. HHS Guide to Getting Started with Telehealth: This guide includes best practice g
Slide 26: Additional Resources to Assist Providers in Getting Started
Additional Resources to Assist Providers in Getting Started in Telehealth Center for Connected Health Policy: Telehealth cchpca.org/all-telehealth-policies/ The Centers for Medicare & Medicaid Services (CMS) has a website dedicated to Medicare telehealth guidelines that includes several useful links
Slide 27: Telehealth Provisions
Telehealth Provisions
Slide 28: General Telehealth and Telemedicine Provisions
General Telehealth and Telemedicine Provisions • Services must be obtained from a participating provider. • Services can be used when care is needed now for non-emergency medical issues and for routine or non-urgent appointments as well. • To be reimbursable, all telemedicine/telehealth services mus
Slide 29: Molina General Telehealth Requirements
Molina General Telehealth Requirements • Molina does not charge providers for offering telehealth services to Molina members. Also, there are no monthly fees. • Services can be provided via telephone or video conference through a computer. o No other special equipment is required. o Funds are not pr
Slide 30: Getting Added as a Telehealth Provider in the Directory
Getting Added as a Telehealth Provider in the Molina Provider Directory Molina offers a visual icon in our Provider Online Directory (POD) that indicates whether a provider offers telehealth services. If your organization adds telehealth capabilities and you would like to have this added to the POD,
Slide 31: Provider Responsibilities
Provider Responsibilities
Slide 32: Provider Responsibilities
Provider Responsibilities Services must be Rendering Covered Services provided through store- coded in providers must and-forward technology must include an in- accordance with comply with person office visit to determine diagnosis or applicable applicable federal treatment. reimbursement and state
Slide 33: Provider Responsibilities, Continued
Provider Responsibilities, Continued Molina has the right to demonstrate and test the Providers are responsible for provider's telehealth service verifying member eligibility. platform and operations upon at least 10 days prior notice to the provider. Obtaining Approval for Services Providers are pr
Slide 34: Available Telehealth Locations for Medicaid Members
Available Telehealth Locations for Medicaid Members Medicaid-covered individuals can access telehealth services wherever they are located. Locations include, but are not limited to: • Home • School • Temporary housing • Homeless shelter • Nursing Facility • Hospital • Group home • Intermediate Care
Slide 35: Available Telehealth Locations for Medicaid Members, Continued
Available Telehealth Locations for Medicaid Members, Continued Patient Site—the physical location of the patient at the time a health care service is provided through the use of telehealth. Practitioner Site – the physical location of the treating practitioner at the time a health care service is pr
Slide 36: Telehealth Special Populations
Telehealth Special Populations The Ohio Department of Medicaid (ODM) requires these specific telehealth rules to be followed by providers for special populations within the Medicaid population. English as a second Comply with the Pediatric: Encounters Homebound/Geriatri language: Provide Americans w
Slide 37: Telehealth Member Eligibility & Benefits
Telehealth Member Eligibility & Benefits
Slide 38: Member Eligibility
Member Eligibility Telehealth services through in-network providers are available to all active Molina Medicaid, MyCare Ohio, Medicare and Marketplace members. Molina does not impose age limits (pediatric patients must have a caregiver present). Providers have the right to impose a general age limit
Slide 39: Member Eligibility Verification
Member Eligibility Verification Member eligibility verification can be completed in a variety of ways, including: • Contact the Molina Provider Services Department Monday-Friday via telephone at (855) 322-4079 during the following business hours: o Medicaid: 7 a.m. to 8 p.m. o MyCare Ohio: 8 a.m. to
Slide 40: Member Eligibility Verification, Continued
Member Eligibility Verification, Continued Log into the Molina Availity Essentials Portal and go to the Eligibility and Benefits Inquiry tab. Possession of a Molina ID card does not guarantee member eligibility or coverage. Providers should verify the eligibility of Molina members prior to rendering
Slide 41: Member Telehealth Resources
Member Telehealth Resources Molina shares member-facing resources with providers that they can give their patients about preparing for a telehealth visit. Molina has prepared a useful document, Tips for a Telehealth Visit, to assist members with understanding and preparing for telehealth visits. Som
Slide 42: Molina Member Website Telehealth Links
Molina Member Website Telehealth Links If Molina members have questions about their telehealth benefits, they should be directed to the Molina member website based on their specific line of business. Medicaid: Molina Medicaid Member Telehealth Medicare: Molina Medicare Member Telehealth MyCare Ohio:
Slide 43: Telehealth Benefits
Telehealth Benefits Some services covered via telehealth/telemedicine include, but are not limited to, the following: Long-Term Services and Supports Including Nursing Assessments Behavioral Health Services Inpatient and Outpatient Medical Consultations Physical, Occupational and Speech Therapies Pr
Slide 44: Recent Expansion of Telehealth Services
Recent Expansion of Telehealth Services Effective July 1, 2022, OAC 5160-1-18 Telehealth was expanded to include the following services for Medicaid and MyCare Ohio members. • Individual diabetes management training • Group setting diabetes management training • Childbirth prep/Lamaze classes • Chil
Slide 45: Recent Expansion of Telehealth Services, Continued
Recent Expansion of Telehealth Services, Continued Behavioral health services that are eligible for payment when provided through telehealth by Ohio Department of Mental Health and Addiction Services (OhioMHAS) certified providers were expanded to include the following: • Mobile Response Stabilizati
Slide 46: Telehealth Claims and Billing
Telehealth Claims and Billing
Slide 47: Telehealth Billing Guidelines: Medicaid
Telehealth Billing Guidelines: Medicaid • Providers must follow CMS guidelines as well as the ODM Telehealth Billing Guidelines located here: ODM Telehealth Billing Guidelines. • All telehealth claims for Molina members must be submitted to Molina with correct codes and appropriate modifiers for the
Slide 48: Telehealth Billing Guidelines: MyCare Ohio with Medicaid as Primary
Telehealth Billing Guidelines: MyCare Ohio with Medicaid as Primary • The GT modifier and any other appropriate modifiers should be included on all telehealth claims, and the POS should accurately reflect the physical location of the practitioner. • The only exception to this guidance is for Home He
Slide 49: Telehealth Billing Guidelines: MyCare Ohio with Medicare Primary
Telehealth Billing Guidelines: MyCare Ohio with Medicare Primary • Use the telehealth POS Code 02, which certifies that the service meets the telehealth requirements. By coding and billing a POS 02 with a covered telehealth procedure code, the provider is certifying the member was present at an elig
Slide 50: Telehealth Provider Billing Guidelines: Specialty Specific
Telehealth Provider Billing Guidelines: Specialty Specific
Slide 51: Outpatient Hospital Behavioral Health Services (OPHBH)
Outpatient Hospital Behavioral Health Services (OPHBH) • Hospitals are eligible to provide outpatient behavioral health services via telehealth to the extent they appear on the OPHBH fee schedule on the ODM Outpatient Hospital Behavioral Health Codes and Rates website. • A list of allowable teleheal
Slide 52: Outpatient Hospital Behavioral Health Services (OPHBH), Continued
Outpatient Hospital Behavioral Health Services (OPHBH), Continued • For services delivered via telehealth, providers may use either the POS code that reflects the location of the practitioner or the location of the patient. o The appendix to Ohio Administrative Code Rule 5160-27-03 includes a list o
Slide 53: Home Health Services, RN Assessment and RN Consultation
Home Health Services, RN Assessment and RN Consultation These services should be billed Telehealth can be used to provide using the procedure codes below. home health services, RN assessment The value 02 should be used to services and RN consultation services indicate telehealth as the POS on when c
Slide 54: Nursing Facilities
Nursing Facilities Nursing Facilities (NF) are reimbursed for all telehealth- related services through the NF per diem rate. Nursing Facilities do not bill for the telehealth-related services they provide. Per the telehealth OAC 5160-1-18, physicians and other eligible providers may bill for the ser
Slide 55: FQHC Facilities
FQHC Facilities Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) billing: The face-to-face requirement is waived for a covered telehealth service that is also an FQHC or RHC service. Payment is made in accordance with Ohio Administrative Code Rule 5160-28. 55
Slide 56: Instructions for Specific Providers and Program Areas
Instructions for Specific Providers and Program Areas: For specific information about billing for the specialty providers listed in this presentation, or programs such as Dental or Hospice please visit ODM Telehealth Guidelines for Managed Care Entities. For additional Ohio Medicaid Telehealth Provi
Slide 57: Teladoc Health Services
Teladoc Health Services ®
Slide 58: What is Teladoc Health (Teladoc)?
What is Teladoc Health® (Teladoc)? • A national vendor that Molina contracts with to provide a value-added benefit available to Molina Medicaid and Marketplace members. • Teladoc services are available for members if their primary care physician does not offer or have availability for telehealth ser
Slide 59: Who is Eligible to Use Teladoc?
Who is Eligible to Use Teladoc? Medicaid: Active Molina Medicaid members 19 and older, except children with special healthcare needs who become eligible at age 21. Marketplace: Active Molina Marketplace members 18 and older. 59
Slide 60: General Teladoc Provisions
General Teladoc Provisions • Like telehealth visits offered by Molina network providers, • Free language members can meet with U.S. services provided to board-certified doctors people whose primary specializing in Internal language is not Medicine or Family Practice. English, such as qualified inter
Slide 61: What is Covered under Teladoc
What is Covered under Teladoc • Teladoc is only for general medicine consultations and does not replace a primary care doctor. The services exclude specialist consultations. • General medical services for non emergency healthcare needs include but are not limited to the following conditions: • Cold
Slide 62: What is Covered under Teladoc: Behavioral Health Services
What is Covered under Teladoc: Behavioral Health Services Available to Medicaid members only • Members receive care from a board-certified psychiatrist, psychologist or licensed therapist that the member chooses. • The member chooses a therapist, selects a date and time (and can set up recurring vis
Slide 63: How Members Can Sign Up for Teladoc
How Members Can Sign Up for Teladoc Medicaid Members Marketplace Members • Online at teladoc.com/Molina-OH/ • Online at member.teladoc.com/ • Mobile App: Download the app at MolinaMarketplace Teladoc.com/mobile and click “Set up • Mobile App: Download the app at your account.” Teladoc.com/mobile and
Slide 64: Contact Molina
Contact Molina
Slide 65: Molina Provider Training Survey
Molina Provider Training Survey The Molina Provider Relations Team hopes you have found this training session beneficial. Please take a few minutes to complete the Molina Provider Training survey to provide feedback on this session. The survey is located on the You Matter to Molina Page of our Provi
Slide 66: Molina of Ohio Provider Relations Contact Information
Molina of Ohio Provider Relations Contact Information Molina has designated email addresses based on provider types to help get your questions answered more efficiently or to connect you to training opportunities: Provider Type PS Rep. Email Address Jeanneen Physician groups, Specialists, FQHC Non-B
Slide 67: Molina Provider Relations Contact Information, Continued
Molina Provider Relations Contact Information, Continued Contact information for hospital-affiliated providers or groups: Jeremy Hospital Region Representative Email Address All State Jeremy Swingle OHProvider.RelationsHospital@ MolinaHealthcare.com Christopher All State Christopher Jones OHProvider
Slide 68: Questions Open Discussion
Questions Open Discussion Thank you for participating in today’s meeting!
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