Welcome to the Provider Registration Page
If you have any questions about the registration process, Please visit our FAQ
For more information please Contact Provider Services Help Desk
Provider Information
Are you registering for:* Start Here Help Help * Help correct × * Help correct ×
Provider Type: *
* Help × correct
Enter any 3 of the below if you don’t know your Provider Id
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This is a required Mandatory field for all pay to providers.
Your Molina Provider ID is a unique ID that is given to you by Molina Healthcare. This is a required field for registering. If you do not have your Molina Provider ID, please contact your Provider Services Representative.
National Provider Identifier is a unique identification number given to health care providers by the Centers for Medicare and Medicaid/Marketplace Services. If you have an NPI Number, please enter it in the designated field.
If you have a State License Number, please enter the number in the designated field.
If you have a Medicare Number, please enter the number in the designated field to access Medicare account.
If you have a Medicaid/Marketplace Number, please enter the number in the designated field to access Medicaid/Marketplace account.
This field is optional. If you have a Drug Enforcement Administration (DEA) Number, please enter the number in the designated field.
Must have at least 8 and no more than 15 characters.
Combination of letters and numbers may be used, Special characters are now limited to ONLY Period "." and the Under score "_", Should not end with Period(.)
Must have at least 8 and no more than 12 characters.
Must contain at least one uppercase and lowercase letter, at least one number.
Must have at least one number
Password cannot contain partial User ID, first name or last name
This is a required field. This is to ensure security upon creating a user account.
As a condition of participating in Molina Web Portal Access, user must agree to the Provider Online User Agreement.
Please select a state if you are registering for a medicaid/Marketplace program.
Medicaid/Dual Options.
Please select this option if you are a Medicaid, Marketplace, or Molina Dual Options (Medicare-Medicaid Plan) provider.
Submit Claim Alert
You have completed claims that have not been submitted. Do you want to submit?
Waiver Service Plan Signature
Your agreement to provide this service is required.   

By "checking this box" or "providing your signature", you are acknowledging and affirming agreement to provide services as authorized per this waiver service plan.
Waiver Service Plan Signature
Thank you for submitting Waiver signature.
Waiver Service Plan Signature
Due to some problem we could not process your request. Please try again later.
Provider Portal
You are not authorized to perform this action.
Web-Portal
Effective 01/01/2020:
Some services will be handled by eviCore.
Please verify codes prior to submitting a
Service request/authorization.
You can find the Current PA Code Guide here
eviCore Website