Molina Healthcare Inc · NYSE:MOH
Molina Healthcare — Investor Presentation (2026)
56 slides from Molina Healthcare's investor presentation, 2026
Slide 1: You Matter to Molina: Introduction to Telehealth
You Matter to Molina: Introduction to Telehealth 2026 | Molina Healthcare of Ohio, Inc. MHO-PROV-0174 0126
Slide 2: Agenda
• Introduction to Telehealth • Getting Started with Telehealth • Telehealth Provisions • Provider Responsibilities • Telehealth Member Eligibility & Benefits AGENDA • Telehealth Claims & Billing • Telehealth Provider Billing Guidelines • Teladoc Health® Services • Contact Molina • Provider Resources
Slide 3: ODM Provider Online Directory and OH|ID
ODM Provider Online Directory and OH|ID As a reminder, 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 are re
Slide 4: Introduction to Telehealth
Introduction to Telehealth
Slide 5: 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 6: 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 7: 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 physical consultation, diagnosis and care to members in limitations and management rural areas transportation plan for hardships patients More flexibil
Slide 8: Getting Started with Telehealth
Getting Started with Telehealth
Slide 9: Factors to Consider When Preparing to Offer Telehealth Visits in Your Practice
Factors to Consider When Preparing to Offer Telehealth Visits in Your Practice • Staffing: Will you need a telehealth • Meeting Patient Needs: Will your patients coordinator? How will staff roles require special accommodations? Will your change? How will you train your current health patients need h
Slide 10: 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 11: Additional Resources to Assist Providers in Getting Started in Telehealth
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 link
Slide 12: Telehealth Provisions
Telehealth Provisions
Slide 13: 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 14: 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 15: Getting Added as a Telehealth Provider in the Molina Provider 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 16: Provider Responsibilities
Provider Responsibilities
Slide 17: Provider Responsibilities
Provider Responsibilities Services must be Rendering providers Covered Services provided through store- coded in accordance must comply with and-forward technology must include an in- with applicable applicable federal and person office visit to determine diagnosis or reimbursement state guidelines
Slide 18: Provider Responsibilities, Continued
Provider Responsibilities, Continued Molina has the right to demonstrate and test the provider's telehealth service Providers are responsible for verifying platform and operations upon at least 10 member eligibility. days prior notice to the provider. Obtaining Approval for Services that Providers a
Slide 19: 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 20: 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 21: 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. Limited English Comply with the Pediatric: Encounters Homebound/ Geriatric: Proficiency (LEP): Provide Ame
Slide 22: Telehealth Member Eligibility and Benefits
Telehealth Member Eligibility and Benefits
Slide 23: 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 24: 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., Mon-Fri. o MyCare Ohio
Slide 25: 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 26: 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 27: 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 28: 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 29: 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 30: 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 31: Telehealth Claims and Billing
Telehealth Claims and Billing
Slide 32: 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 33: 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 34: Telehealth Billing Guidelines: MyCare Ohio with Medicare Primary
Telehealth Billing Guidelines: MyCare Ohio with Medicare Primary • With the expiration of Original Medicare Telehealth benefits as of Sept. 30, 2025 (and no to-date action to further extend telehealth benefits during the government shutdown), CMS recently released guidance allowing Medicare Advantag
Slide 35: Telehealth Provider Billing Guidelines: Specialty Specific
Telehealth Provider Billing Guidelines: Specialty Specific
Slide 36: 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 37: 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 OAC 5160-27-03 includes a list of allowable POS codes for
Slide 38: Home Health Services, RN Assessment and RN Consultation
Home Health Services, RN Assessment and RN Consultation These services should be billed using the Telehealth can be used to provide home procedure codes below. The value 02 health services, RN assessment services and should be used to indicate telehealth as RN consultation services when clinically t
Slide 39: 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 serv
Slide 40: 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 OAC 5160- 28. 40
Slide 41: 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 42: Teladoc Health Services
Teladoc Health Services ®
Slide 43: 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 44: 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. 44
Slide 45: General Teladoc Provisions
General Teladoc Provisions • Like telehealth visits offered by Molina network providers, • Free language services members can meet with U.S. provided to people whose board-certified doctors primary language is not specializing in Internal Medicine English, such as qualified or Family Practice. inter
Slide 46: 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: o Cold
Slide 47: 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 48: How Members Can Sign Up for Teladoc
How Members Can Sign Up for Teladoc Medicaid Members Marketplace Members • Online at teladochealth.com/ benefits/molina/oh • Online at member.teladoc.com/ • Mobile App: Download the app at MolinaMarketplace Teladoc.com/mobile and click “Set up your • Mobile App: Download the app at account.” Teladoc
Slide 49: Contact Molina
Contact Molina
Slide 50: 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 51: 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 Email Address Physician groups, Specialists, FQHC Non-BH Providers, Adva
Slide 52: Provider Resources
Provider Resources
Slide 53: 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 54: Provider Bulletin
Provider Bulletin A monthly Provider Bulletin is sent to Molina’s provider network to share news and updates. The Provider Bulletin includes: • Prior authorization changes • Training opportunities • Updates to the Availity Essentials Portal • You Matter to Molina Corner To join our distribution list
Slide 55: 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 56: Questions Open Discussion
Questions Open Discussion Thank you for participating in today’s meeting!