Molina Healthcare operates Medicaid managed care plans in 20+ states. Denial patterns follow state Medicaid rules, so the same service may be denied in one state and covered in another. The most common Molina denial codes are CO-197 (no prior auth), CO-50 (non-covered), and CO-29 (timely filing).
Day 1: Claim denied. Days 1-5: Review denial code and EOB. Days 6-10: Gather documentation for appeal or corrected claim. Days 11-15: Submit appeal or corrected claim. Days 16-45: Molina review period. Day 46: Decision issued. If denied: state fair hearing available.
| CARC Code | Reason | Primary Cause | Fix |
|---|---|---|---|
| CO-197 | Precertification absent | Prior auth not obtained | Check PA list before service |
| CO-50 | Non-covered service | Not in state Medicaid benefits | Verify coverage before scheduling |
| CO-29 | Timely filing | Filed after state deadline | Submit within 30 days of service |
| CO-22 | Coordination of benefits | Other payer not identified | Verify COB at eligibility check |
Appeal Molina denials within the state Medicaid appeal deadline (typically 30-60 days from denial notice). Submit to the address on the denial letter. Include the member ID, claim number, clinical documentation, and a letter explaining why the denial should be overturned.
CO-197 (no prior auth), CO-50 (non-covered service), CO-29 (timely filing), and CO-22 (coordination of benefits). Exact frequency varies by state because each state Medicaid program has different rules.
Log into the Molina provider portal at molinahealthcare.com. Navigate to Claims and search by member ID or claim number. Status updates are available within 24-48 hours of claim processing.
No. Molina administers Medicaid under state contracts. Coverage, PA requirements, timely filing deadlines, and appeal processes all vary by state. Always reference your state-specific provider manual.
Altair checks Molina's state-specific rules before every claim and flags potential denials.