Provider Bulletin on Availity Appeals Changes

This document is a provider bulletin issued by Molina Healthcare of New Mexico, Inc. on February 27, 2025, detailing important updates regarding the Availity Appeals and Reconsideration process. It clarifies that Molina does not offer reconsideration services through the Availity platform, correcting previous misinformation that may have caused confusion among providers. The bulletin outlines the proper procedure for submitting disputes, which requires the use of the Provider Reconsideration Review Request (PRR) Form. It details two main options for providers: Claim Payment Inquiry/Reconsideration and Claim Payment Dispute/Appeal, each with specific categories and examples. The document emphasizes the importance of following established guidelines and provides resources for further assistance, including links to Molina’s provider manuals and contact information for the Provider Relations team. This ensures that providers can navigate the claims process effectively and address any issues that arise.