MedicaidAdministrativeMedium impact
Provider Bulletin 08-20-2025 Implementing New Provider Request Forms IM IE LA OC SAC SD
Molina Healthcare·CA·Provider Bulletin
Effective date
Aug 20, 2025
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California is implementing new mandatory forms for all provider update requests (adds, terminations, demographic changes, panel changes, etc.) effective immediately. All requests must now include specific forms submitted to designated county email inboxes to avoid processing delays.
Action Required
Immediately: Administrative staff must begin using new Molina forms for all provider update requests. Download Provider Profile Form for new providers, Clinic Profile Form for new clinics, Update Information Form for changes, and Term Provider Form for terminations from Molina website. Submit completed forms to appropriate county inbox (varies by location). Failure to use required forms will cause processing delays.