How to Submit a Superbill to Molina Healthcare

Molina Healthcare primarily serves Medicaid and ACA Marketplace members. Before submitting an OON therapy superbill to Molina, you need to verify whether your plan actually includes OON mental health benefits — many Molina plans do not.

Overview: Molina Healthcare and Out-of-Network Mental Health Benefits

Molina Healthcare is a managed care organization that focuses on government-sponsored health programs — primarily Medicaid, Medicare Advantage, and ACA Marketplace plans. Because most of Molina's membership is Medicaid-based, OON mental health benefits are very limited or nonexistent on the majority of Molina plans.

Molina Medicaid (CHIP and state Medicaid) plans generally have no OON benefits for routine outpatient mental health services. Molina Marketplace (individual ACA) plans may have limited OON benefits depending on whether the plan is an HMO or PPO. Before submitting anything, call the Member Services number on the back of your ID card or log in to molina.com to verify your specific plan includes OON mental health coverage. For more context on the general process, see our step-by-step superbill submission guide. For a full overview of Molina coverage, visit our Molina insurance guide.

If you have confirmed that your Molina plan includes OON mental health benefits, the submission process goes through the Molina member portal at molina.com.

Step-by-Step Process for Submitting to Molina

1. Verify OON benefit exists before submitting. This is the most important step. Call Member Services or review your Summary of Benefits and Coverage. If your plan is Medicaid-based or a Molina HMO Marketplace plan, there is likely no OON coverage for routine therapy. Do not proceed to step two unless you have confirmed OON benefits.
2. Get your superbill from your therapist. Request a superbill covering all sessions you want to submit. Molina accepts batch submissions covering multiple dates of service on one claim.
3. Log in to the Molina member portal. Go to molina.com and sign in with your member credentials. Navigate to the claims section and select the option to submit a member claim or out-of-network claim.
4. Complete the online claim form. Enter provider information, dates of service, CPT codes, and amounts charged. Upload the superbill PDF as supporting documentation.
5. Note your confirmation number. After submission, screenshot the confirmation page. Molina processes claims from the date received.

What to Include With Your Molina Claim

Molina requires the superbill to contain all required superbill fields. Confirm your superbill includes:

• Provider full name, NPI (Type 1), and practice address
• Provider Tax ID (EIN or SSN) and professional license number
• Your name, date of birth, and Molina member ID number
• Date(s) of service
• CPT procedure code (e.g., 90837 for 60-minute therapy) and description
• ICD-10 diagnosis code (e.g., F41.1 for generalized anxiety)
• Place of service code (11 for office; 10 for telehealth)
• Fee charged per session and amount you have already paid

Molina's Processing Timeline

When Molina does process OON claims, the timeline is typically 45–60 days from receipt — longer than many commercial insurers. You will receive an Explanation of Benefits (EOB) in your Molina portal or by mail. Payment arrives by check for eligible OON claims.

Molina's filing deadline varies by plan — most allow 180 days from the date of service. Verify your plan's specific deadline.

Common Issues When Submitting to Molina

• No OON benefit: The most common issue — attempting to submit an OON superbill when the plan has no OON coverage. Always verify first.
• Medicaid plan limitations: Molina Medicaid plans follow state Medicaid rules, which virtually never include OON mental health benefits for routine outpatient therapy.
• Portal navigation: Molina's portal layout can vary by state. If you cannot find the OON claims section, call Member Services for guided navigation.
• Prior authorization requirements: Some Molina plans require prior authorization for mental health services. Submitting without authorization on an authorization-required plan will result in denial.

Tips for a Smooth Molina Claim

• Always call Member Services to verify OON mental health benefits before beginning treatment with a Molina client. This single step prevents most submission problems.
• Use the Molina member portal to track claim status after submission.
• If your claim is denied, you have the right to a formal appeal. Include clinical documentation and the specific plan language citing OON benefits in your appeal letter.
• If your client has no OON coverage, provide a superbill anyway — it may be usable for HSA or FSA reimbursement depending on your client's account type.

Superbilled makes it easy to generate Molina-ready superbills with all required fields pre-filled. After verifying OON benefits, use the steps above to submit through the Molina member portal.