EDI

Types of EDI Transactions

Electronic Data Interchange (EDI) functionality is utilized by Molina to complete several types of ASC X12N Version 5010 transactions, including:

• Claims Submission (837 Professional and Institutional Healthcare Claims)
• Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) – (835 Healthcare Claim Payment/Advice)
• Referral Certification and Authorization (278 Healthcare Services Review - Request for Review and Response)
• Eligibility for a Health Plan (270/271 Healthcare Eligibility Benefit Inquiry and Response)
• Claims Status (276/277 Healthcare Claim Status Request and Response)

EDI Claims Submission

The easiest way to submit EDI claims to Molina Healthcare is through a Clearinghouse. You may submit the EDI claims through your own clearinghouse or use Molina’s contracted clearinghouse (see the Clearinghouse Information for Payer ID information). If you do not have a Clearinghouse, Molina offers additional electronic claims submissions options. Log on to Molina's Provider Services Web Portal for additional information about claims submission options available to you.

270/271 Healthcare Eligibility Benefit Inquiry and Response & 276/277 Healthcare Claim Status Request and Response

Molina does not directly exchange 270/271 and 276/277 transactions. The 270/271 and 276/277 transactions are handled by Molina’s contracted clearinghouse The SSI Group. The transactions may be sent directly to SSI or via your own clearinghouse.

EDI Forms

278 Referral Certification and Authorization Form

The 278 Request transaction is utilized to verify medical necessity for health care services; therefore, additional supporting documentation may be necessary for approval of requested services.

 278 - Request for Review and Response