Contact Information
Phone Numbers
Fax Numbers
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VendorsCVS/Caremark – Pharmacy
Telephone:
Prior Auths, Inquiries: (877) 872-4716 Retail Drugs only: (800) 364-6331 Fax: (844) 823-5479 Liberty Dental – Dental Services
Medicaid
Liberty Dental Plan NY.com Telephone: (888) 352-7924 Eligibility & Benefit Option 1 Emails: claims@LibertyDentalPlan.com Telephone: (888) 352-7924 Option 2
Fax: (888) 401-1129 Paper Claims by Mail or Corrected Claims by Mail: Emails: GandA@LibertyDentalPlan.com
Mailing Address: Liberty Dental Plan
ATTN: Grievances & Appeals
P.O. Box 26110
Santa Ana, CA 92799-6110
Provider Relations Department Telephone: (888) 352-7924
Fax: (949) 313-0766
Liberty Dental Plan
ATTN: Provider Relations
P.O. Box 26110
Santa Ana, CA 92799-6110
Email: Provider@LibertyDentalPlan.com
Superior Vision / Versant Health –Vision Services Telephone: (866) 819-4298 PAYER ID: 41352 Paper Claims |
Claims Department
The Claims Department is located at our corporate office in Long Beach, CA. All hard copy (CMS-1500, UB-04) claims must be submitted by mail to the address listed below. Electronically filed claims must use EDI Claims/Payor ID number - 16146. To verify the status of your claims, please call our Provider Claims Representatives at the numbers listed below.
| Claims | |
| Address | Molina Healthcare of New York, Inc. PO BOX 22615 Long Beach, CA 90801 |
| Phone: | (877) 872-4716 |
For more information, refer to the Provider Manual.
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Claim Disputes/Reconsiderations
Providers disputing a Claim previously adjudicated must request such action within 90 days of Molina’s original remittance advice date. Regardless of type of denial/dispute (service denied, incorrect payment, administrative, etc.); all written Claim disputes must be submitted on the Molina Provider Appeal Form found on Provider website and the Provider Portal. The form must be filled out completely in order to be processed. Additionally, the item(s) being resubmitted should be clearly marked as a Claim Payment Dispute and must include the following:
Submission Process:
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