Medicare AdvantageAdministrativeMedium impact
07-07-2026 Provider Bulletin Summary IM IE LA OC SAC SD
Molina Healthcare·CA · General Practice, Internal Medicine, Geriatrics +1 more·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jul 14, 2026
Summary
Molina Healthcare of California has established a new bi-weekly Provider Bulletin distribution schedule (every other Tuesday) summarizing all provider communications. This bulletin covers seven key updates effective immediately or as specified: 2026 Provider Manual updates across all lines of business, clinical guidance on infectious disease monitoring during the 2026 World Cup, SNF/LTC billing reminders to reduce denials, Medi-Cal enrollment restriction procedures, SNF Workforce Quality Incentive Program requirements (APL 26-006), and Private Duty Nursing case management responsibilities for members under 21 (APL 26-009). Billing teams must review full policy details online and ensure compliance with all regulatory requirements.
Action Required
REQUIREMENTS:
- Immediately: All billing and clinical staff must subscribe to Molina Healthcare Provider Bulletins by submitting the email notification form at qfreeaccountssjc1.az1.qualtrics.com/jfe/form/SV_b4naTMFNV5055Ou to receive bi-weekly updates.
- By July 15, 2026: Billing team must review the complete 2026 Provider Manual updates (Marketplace, Medi-Cal, and Medicare) available at the specified URLs for new program requirements and policy changes effective immediately. Update billing software, encounter forms, and workflows accordingly.
- Immediately: SNF/LTC providers must implement billing reminders per the July 1 bulletin: verify claim status, member authorization, member eligibility, and correct revenue codes before submission to reduce denials and improve claims processing efficiency.
- Immediately: SNF/LTC providers and case managers must implement Private Duty Nursing (PDN) case management procedures per APL 26-009 for Medi-Cal members under 21, including: timely/complete authorization requests, current clinical documentation, care coordination, and prompt communication of service interruptions.
- Immediately: SNF/LTC providers must verify eligibility for the 2023-2025 SNF Workforce Quality Incentive Program (APL 26-006) and ensure accurate, timely claims submission to receive supplemental payments.
- Immediately: All clinical staff must maintain heightened vigilance for infectious diseases (measles, respiratory viruses, tuberculosis) through July 19, 2026, review infection prevention protocols, verify immunizations are current, and report suspected cases promptly to local/state health departments.
- Ongoing: Billing team must monitor the Molina provider website for each line of business (Medi-Cal, Marketplace, Medicare) and Availity Essentials portal for full bulletin details, implementation timelines, and requirements. Do not rely solely on this summary.
- By [30 days from notification]: Contact your assigned Molina Provider Relations Representative if clarification is needed (see contact list by county/service area). Failure to comply with these bulletins and regulatory requirements may result in claim denials, loss of supplemental payments, and compliance violations.