Molina Healthcare Claim Payment Timelines for Providers
Molina is a government-sponsored managed care payer (Medicaid, Marketplace, Medicare) whose rules are set by state Medicaid contracts. Here is how Copay pays you the next business day regardless.
Data as of June 2026. Every figure below is sourced.
What is required by law
These payment floors are set by federal regulation and are the most solid, citable figures for Molina Healthcare.
Medicaid managed care
Verified30 days
Federal floor: pay 90% of clean claims within 30 days of receipt and 99% within 90 days. Molina state manuals generally state clean claims are paid or denied within 30 days; some states differ (for example, Washington uses tiered 30/60/90-day standards).
Medicare Advantage
Verified30 days
Federal floor for Molina Medicare and dual plans: pay 95% of clean claims from non-contracted providers within 30 days, with interest if late; all other non-contracted claims within 60 calendar days.
42 CFR §422.520: Prompt payment by Medicare Advantage organization
Timely filing limits
The deadline to submit a claim from the date of service. Limits can vary by your specific contract and state law.
Medicaid (varies by state)
Commonly 180 to 365 days (e.g., Ohio 365, Illinois 180) (set by each state Medicaid contract)
Marketplace / Medicare
Commonly 180 to 365 days
Commercial payment timing
Industry pattern, not a payer commitment
VerifiedMolina's clean-claim and payment timelines are set by state Medicaid contracts and state prompt-pay law, so they vary by state and line of business. Most Molina state manuals state clean claims are paid or denied within 30 days of receipt; some states differ (Washington uses tiered 30/60/90-day standards). There is no single national Molina commercial number.
Common denial categories
Generally-known categories that apply across payers, including Molina Healthcare.
- Timely filing expired
- Duplicate claim
- No or invalid prior authorization
- Member not eligible on date of service
- Medical necessity not met
- Coding or bundling errors
- Coordination of benefits / primary payer
- Out-of-network provider
- Benefit maximum or frequency exceeded
How Copay works with Molina Healthcare claims
Copay purchases your eligible Molina claims and pays you the next business day, regardless of how long Molina takes to adjudicate. You connect your billing software once and submit claims exactly as you do today. It is non-recourse, so a denied eligible claim is Copay's loss, not yours.
Molina Healthcare, answered
It depends on the state and line of business, because Molina's timelines are set by state Medicaid contracts and prompt-pay law. Most state manuals say clean claims are paid or denied within 30 days (Washington uses tiered 30/60/90-day standards). The Medicaid federal floor is 90% of clean claims within 30 days and 99% within 90 days.
It varies by state and line of business, commonly 180 to 365 days from the date of service (for example, Ohio Medicaid is 365 days and Illinois Medicaid is 180 days). Confirm against your specific Molina state provider manual.
Yes. Copay purchases your eligible Molina claims and funds you the next business day instead of waiting out adjudication. It is non-recourse and does not change how your billing team works.
Common, generally-known categories include timely filing, duplicates, missing prior authorization, member eligibility, medical necessity, coding or bundling errors, coordination of benefits, out-of-network providers, and exceeding a benefit maximum or frequency.
Sources
Data as of June 2026. Primary and regulatory sources are cited inline above and listed here.
- regulation42 CFR §422.520: Prompt payment by Medicare Advantage organization
- regulation42 CFR §447.45: Timely claims payment (Medicaid: 90% of clean claims within 30 days, 99% within 90 days)
- primaryMolina Healthcare of Illinois 2025 Medicaid Provider Manual
- secondaryIndustry guide (Muni Health): Molina timely filing by line of business
Get paid on your Molina Healthcare claims the next business day.
Connect your billing software once. Non-recourse, no loans, and no changes to how your team works.