MedicaidAdministrativeMedium impact
07-16-2026 Provider Disputes IM IE LA OC SAC SD
Molina Healthcare·CA·Provider Bulletin
Effective date
Jul 16, 2026
We identified it
Jul 22, 2026
Summary
Molina Healthcare of California issued a provider bulletin clarifying the process for submitting Provider Claims Disputes across six California regions (Imperial, Riverside, San Bernardino, Los Angeles, Orange, Sacramento, San Diego). The policy reinforces the preferred method of dispute submission through the Availity Essentials Portal and establishes a 45 working day resolution timeline after receipt of complete disputes. This is a procedural reminder rather than a substantive policy change.
Action Required
Immediately: Billing team must ensure all staff are aware of the updated Provider Claims Dispute process for Molina Healthcare of California Medi-Cal and Marketplace plans. (1) Prioritize submission of disputes through the Availity Essentials Portal by logging in, searching for adjudicated claims, and selecting 'Dispute This Claim' with appropriate supporting documentation. (2) Before submitting disputes, verify the issue cannot be resolved through a corrected claim or payment inquiry/reconsideration to avoid unnecessary submissions. (3) For IPA/Medical Group members on shared-risk capitated arrangements, ensure first-level dispute review is completed by the IPA/Medical Group before Molina final determination. (4) Track all dispute submissions and expect written determinations within 45 working days; if Molina requests additional information in writing, submit within 30 working days or the dispute will be closed. (5) If Availity is unavailable, use alternative methods: fax the Provider Dispute Resolution Request Form to (562) 499-0633 or mail to Molina Healthcare of California, Attn: Provider Dispute Resolution Unit, PO Box 22722, Long Beach, CA 90801. (6) Contact your Molina Provider Relations Representative with any questions. Failure to follow proper procedures may result in disputes being rejected or closed.