MedicaidAdministrativeMedium impact
Provider Bulletin 11-10-2025 ICE Roster Template Enhancements IM IE LA OC SAC SD
Molina Healthcare·CA·Provider Bulletin
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California has released an enhanced ICE Roster Template with new requirements for provider data submission including mandatory provider titles, license states, standardized file naming conventions, and new drop-down menus for data consistency.
Action Required
Immediately: Contact your assigned Molina Provider Relations representative to request the updated ICE Roster Template. Update all future roster submissions to include required Provider Title (MD, PA, NP) and License State fields. Implement new standardized file naming convention including provider group name, NPI, reporting period (Q1-Q4), calendar year, and roster type. Use new drop-down menus for Request Type, Provider Designation, Primary Specialty Board Status, FQHC Location, and Service Location Gender Restrictions to ensure data consistency.