Molina Healthcare Inc · NYSE:MOH
Molina Healthcare — Investor Presentation (2025)
55 slides from Molina Healthcare's investor presentation, 2025
Slide 1: Provider Orientation
¢c 2 oa) 4°) xa — cD) ‘= Og Sun co) aS) => fe] —_ a
Slide 2: Today we'll go over….
Today we’ll go over…. • Who your Provider Relations • Molina's Care Management Support Representative is and how they can help • How and where to submit claims • How to get in touch with Molina Teams • What we’re doing in the community • Molina’s Utilization Management Process • How to register as a
Slide 3: Thank you for partnering with us!
Thank you for partnering with us! Within our population we have great diversity. There are always opportunities that we can watch for cultural differences, domestic violence, abuse or neglect. Our health plan members are often vulnerable individuals. They may have difficulty with language or literac
Slide 4: Molina Membership
Marketplace Molina Membership Medicaid Molina has been in Idaho since 2018 And now serving over 20,400 members! Molina Healthcare in Idaho service areas: Medicaid – Ada, Adams, Bannock, Benewah, Bingham, Bonneville, Blaine, Boise, Bonner, Bonneville, Boundary, Canyon, Cassia, Clark, Clearwater, Elmo
Slide 5: Provider Relations
”) c 2 Pa a) cD) ce Sen co) aS) => fe] Sen a.
Slide 6: Idaho Provider Relations Team
Idaho Provider Relations Team Your Personal Advocates helping you navigate and partner with the Molina team. We provide education about: • Contacts for all departments within Molina. • Credentialing a new provider or making a change to an existing • Healthcare updates and credentialed provider in yo
Slide 7: Need help from your PRR Team?
Need help from your PRR Team? • Keshia Schneider • Stephanie Sanders Manager of Provider Relations Provider Relations Representative Email: Keshia-skye.Schneider@molinahealthcare.com Email: Stephanie.Sanders2@molinahealthcare.com Phone: (801) 613-1918 Phone: (208) 986-0500 Specialties: SNFs, BH & Ho
Slide 8: Contact Center
Sun cD) _ — ic) \S) ~ Oo 4°) xa ¢c e] \S)
Slide 9: Provider Contact Center
Provider Contact Center The Member and Provider Contact Centers support multiple products across all states to assist our members and providers with: • Benefit and Eligibility questions • Provider Network inquiries • PCP updates • Authorization inquiries • Claim Status and inquiries • Grievance and
Slide 10: Community & Member Engagement
Community & Member Engagement
Slide 11: Community & Member Engagement
Community & Member Engagement What does Community & Member Engagement mean for Molina Healthcare of Idaho? What are our goals? How are we working towards these goals? What does success look like?
Slide 12: What is Community & Member Engagement?
Community & Member Engagement What is Community & Member Engagement? 1 Member Engagement Community and Member Engagement is the way • Community events Molina Healthcare of Idaho actively engages with • Member Advisory Committees members, our community partners including • One-on-One member and partn
Slide 13: Community & Member Engagement
Community & Member Engagement IIBHN Conference, AAA's Caregiver 1 Community Sponsorships Conferences, SMART Workshops, and the Hands Around the Capital-ADA Celebration Molina’s community investment platform 2 Molina Cares Accord and our commitment for 2025 is over $75K YTD Molina Signature events th
Slide 14: Community & Member Engagement
Community & Member Engagement
Slide 15: Quality Improvement Population Health Engagement
Quality Improvement Population Health Engagement
Slide 16: Quality Improvement
Quality Improvement • Medicare Star ratings • Medicaid State and Medicare CMS Regulatory Compliance • NCQA Accreditation • Provider Engagement Program • Provider Quality Bonus • Missing Services Lists • Provider and Member Satisfaction • Member Outreach Programs 16
Slide 17: 2025/26 Outreach and Incentive Programs
2025/26 Outreach and Incentive Programs Incentives Outreach Targets Offered Dual-Eligible Preventive services MMCP Range from $25 - $125 IMPlus Maintenance services Marketplace 17
Slide 18: Care works best when caring people work together
Care works best when caring people work together Quality Incentives Alignment: Primary Care HCBS Members BCS - $50 BCS - $75 BCS - $75 CPB - $50 CBP - $75 Flu Shot - $25 COL - $20 COL - $75 COL - $75 Diabetes screenings - $50 Diabetes screenings (3)- $75 Diabetes screenings (3) - $75 AWV - $175 AWV
Slide 19: HEDIS Measures
HEDIS® Measures Provider Goals Purpose – Ensure every Molina Healthcare Complete all appropriate needed HEDIS® member has an assessment of all needed services for all members. HEDIS® metrics within the outlined timeframes. Ensure all services performed are documented on claims/encounters for all
Slide 20: Medicare Quality Performance Measures
Medicare Quality Performance Measures 2025 Medicare Star HEDIS® Measures Breast Cancer Screening (BCS) Care for Older Adults (COA - M) – Medication Review Care for Older Adults (COA - F) – Functional Assessment Colon Cancer Screening (COL) Controlling High Blood Pressure (CBP) Eye Exam for Patients
Slide 21: Provider Support
Provider Support • Provider Incentives and programs to promote patient wellness and preventive care. • HEDIS® Tip Sheets on the Availity Portal; Performance reporting; Designated Quality Specialist. • HEDIS® metric reports and missing service reports available. NEW in 2026! PCS Provider Advisory Com
Slide 22: Member Engagement
Member Engagement Text Campaigns: Reminders to schedule appointments, education, community & health plan resources. Incentive programs Member Advisory Committee (MAC):Quarterly meetings, in-person & virtual options. Open to Molina members, Family/friend caregivers. 22
Slide 23: 2025 Medicare Member Healthy Reward Incentive Program
2025 Molina Healthcare Idaho Medicare Member Healthy Reward Incentive Program Quality measure Reward Amount Member Tips Breast cancer screening $75 Rewards are loaded on MyChoice debit card. Colon cancer screening $75 Incentives earned fund food & produce purchases. Diabetes (A1c, Eye exam, Kidn
Slide 24: Monitoring Satisfaction
Monitoring Satisfaction Member Satisfaction Survey Consumer Assessment of Healthcare Providers and Systems (CAHPS) Measures member satisfaction with: 1. Rating of All Health Care 2. Rating of Health Plan 3. Rating of Personal Doctor 4. Rating of Specialist Seen Most Often 5. Preventive Services Prov
Slide 25: Provider Registration and Contracting
Provider Registration and Contracting p
Slide 26: IDHW/Medicaid Provider Registration
IDHW/Medicaid Provider Registration • When Molina Healthcare of Idaho (MHID) receives notification from the Idaho Department of Health & Welfare (IDHW) that a provider is not registered with the State, MHI will terminate the effected lines of business, including Medicaid and Medicare. • When the pro
Slide 27: IDHW Provider Registration 2026
IDHW Provider Registration 2026 Effective January 1, 2026, the Idaho Department of Health & Welfare (IDHW) will require all providers to register to participate in Medicaid programs. This new regulation aims to ensure high standards of care, enhance patient safety, and to maintain the integrity of c
Slide 28: Contracting
Contracting • If you would like to become contracted with Molina Healthcare of Idaho or have questions about your contract, please email the Idaho Provider Contracting team at MHIDProviderContracting@MolinaHealthCare.Com Please attach a Contract Request Form and current W-9 dated within the last 1
Slide 29: CAQH
CAQH The Council for Affordable Quality Healthcare • CAQH ProView is more than a credentialing database. Available at no cost to you, CAQH ProView eliminates duplicative paperwork with organizations that require your professional and practice information for claims administration, credentialing, dir
Slide 30: Appeals and Grievances
A) y oO c © > 7 ‘< O S = © — © Y o. 2. <
Slide 31: Provider Appeals & Reconsiderations
Provider Appeals & Reconsiderations Provider Claims Appeal is a formal written request for review of a claim denial or partial payment. All claim appeals must be clearly identified as “Provider Claims Appeal” by If the Provider would like to dispute the written request and be accompanied with all ne
Slide 32: Provider Appeals
Provider Appeals If the Provider would like to formally dispute the processing, payment or nonpayment of a claim, the dispute shall be classified as a Provider Appeal. The Appeal must be filed within the specified timeframe from the date of the Health Plan’s Action. Providers should submit the follo
Slide 33: Submitting Provider Appeals Forms
Submitting Provider Appeals Forms Forms may be submitted via Availity, fax, or mail. Appeals submitted via Availity at: https://availity.com/molinahealthcare Medicaid Plus & Marketplace Appeal Form: Provider Claims Appeal Request Form Medicaid Plus & Marketplace Appeals: Molina Healthcare of Idaho,
Slide 34: Healthcare Services
A) wo 4 > S= 7) 7) oD Son © O < = © oo) <
Slide 35: Molina Care Management
Molina Care Management Improving Care One Member at a Time • Less fragmented care • Delivery of service at the Right place, Right time and Right level of care • Member centric/Improved outcomes • Medication reconciliation (Poly Pharmacy) • Use of Motivational Interviewing, to empower and encourage s
Slide 36: Case Management Structure
Case Management Structure *Molina Healthcare’s Integrated Care Management program is a collaborative process aimed at meeting an individual’s health needs, promoting quality of life, addressing social determinants of health and obtaining the best possible outcomes for the member, delivering the righ
Slide 37: Idaho Care Management by Line of Business
Idaho Care Management by Line of Business MMCP Medicaid Plus Waiver Members • Voluntary program with • Mandatory program for all • Coordination of all HCBS one set of comprehensive dual eligible members who and LTSS services & needs benefits are given Medicaid • Provider notification of UAI • Assess
Slide 38: Is a Prior Authorization Required?
Is a Prior Authorization Required? Molina’s preferred method is the Code Look Up Tool on the Molina Healthcare website under Health Care Professionals. Health Care Professionals (molinahealthcare.com) • Medicaid - Provider Forms (molinahealthcare.com) • Medicare - Medicare Providers (molinahealthcar
Slide 39: Utilization Management and Prior Authorizations
Utilization Management and Prior Authorizations How to obtain a Prior Authorization Prior Authorizations can be obtained by: • Faxing PA form to UM Team • Submit through Availity PHONE FAX Medicaid (888) 483-0760 (866) 472-0589 Marketplace (855) 322-4081 (833) 322-1061 Medicare MMP (855) 322-4081 (8
Slide 40: Claims & Payments
7) ~~ c cD) = =~ i) a. (oa) ”) £ = \S)
Slide 41: Molina is Green
Molina is Green Molina requires all contracted Providers to participate in and comply with Molina’s electronic solution requirements which include but are not limited to electronic submission of prior authorization requests, prior authorization status inquiries, health plan access to electronic medi
Slide 42: Black and Red Claim Submissions
Black and Red Claim Submissions In order to accurately process paper claim submissions, a provider must bill on acceptable claim forms to ensure accuracy of the data being input into our systems. CMS guidelines state: “For both CMS-1500 and UB-04 Claims, the only acceptable claim forms are those pri
Slide 43: Corrected Claims Submission
Corrected Claims Submission • Providers can submit corrected claims when changing or adding information, such as a change in coding. • There are 2 ways to submit a corrected claim to Molina Healthcare: 1. Electronic Data Interchange (EDI) 2. Availity Portal • Tips on submitting corrected claims: − A
Slide 44: Billing Molina Members
Billing Molina Members • The Provider is responsible for verifying eligibility and obtaining approval for those services that require prior authorization. • Providers, as well as subcontractors and referral providers, agree that under no circumstance shall a Member be liable to the Provider for any
Slide 45: EFT and EDI Enrollment & Support
EFT and EDI Enrollment & Support ECHO Health Inc. Website www.providerpayments.com More information can be found on our website as well: EFT/ERA Customer Service (888) 834-3511 Email EDI.ERAEFT@MolinaHealthcare.com Register Echo Enrollment Submitting Electronic Claims, Encounters, Referral Certifica
Slide 46: Provider Portal in Availity
Provider Portal in Availity
Slide 47: Getting Started with Availity
Getting Started New Availity Portal Users Existing Availity Portal Users • Go to Welcome to Molina Healthcare, Inc - ePortal Services • Go to Availity Essentials • Go to Molina Healthcare of Idaho Home • From the Healthcare Provider Home page select one of the two links: Training Resources within Av
Slide 48: Availity Features
Availity Features Claims submission & Monitoring Prior Authorization Appeals HEDIS Gaps in Care Tool Claims Reconsiderations Member Eligibility Smart Home Page Training Guides & Resources 2 Way Secure Messaging Care Coordination Portlet Member Specific Benefits Claims Corrections Molina & Availity u
Slide 49: Medicare Advantage D-SNP Plans
Medicare Advantage D-SNP Plans
Slide 50: Idaho State Map Market overview
Idaho State Map Market overview 2025 existing counties (34) Service areas and products 2026 expansion counties (9) D-SNP plans: Molina Medicare Complete Care (HMO D-SNP) H5628-013-001 2026 total counties (43) (FIDE) Service area (5): Ada, Boise, Canyon, Gem, Owyhee 2026 new plan Molina Medicare Comp
Slide 51: Idaho Key Supplemental Benefits
Idaho Key Supplemental Benefits Benefits SSBCI benefits* Transportation for Chiropractic OTC non-medical needs Personal emergency response system Fitness Healthy food allowance (PERS+) Utilities (electricity, natural gas and Hearing Podiatry water) Home-delivered meals Vision Non-emergency medical W
Slide 52: Molina Healthcare: Idaho – D-SNP
Molina Healthcare: Idaho – D-SNP Service Area (5): Ada, Boise, Canyon, Gem, Owyhee Pre-Funded MyChoice Plan Premium PCP/Specialist Prescriptions Dental Hearing Vision Debit Card Benefits* Molina Medicare $0 $0/$0 copay Tier 1 & Tier 6: $0 Idaho Smiles $0 exam $0 exam $143 a month in healthy Complete
Slide 53: Molina Pre-Funded MyChoice Debit Card
Molina Pre-Funded MyChoice Debit Card Healthy food allowance: • Over the counter (OTC): • Beverages • Allergy, flu and cold medicine • Bread, grains and flour • Pain relievers • Baking and cooking mixes • Fever reducers • Processed cereal products • First aid items • Fruits and vegetables • Vitamins
Slide 54: NationsBenefits
NationsBenefits With NationsBenefits’ all-in-one pre-funded debit card solution, • Food and produce* Molina Healthcare empowers members to effortlessly pay for • OTC and transportation* eligible items and approved services, bringing added convenience, • Hearing choice, and value to their health care
Slide 55: Questions?
Questions? Team/Department Email Contact Provider Relations MHIDProviderSvcReq@MolinaHealthCare.Com Contracting MHIDProviderContracting@MolinaHealthCare.Com Provider Network Services MHIDPNA@MolinaHealthCare.Com Care Management MHIDCaseManagement@MolinaHealthcare.com Utilization Management MHIDPrior