Provider Resources & Forms


In need of a form, have a question or need more information on a topic, choose from the resources below.  If you can't find what you are looking for or need more help, don't hesitate to email us at


Administrative Forms

Credentialed Ancillary Facility Data Form 

Data Forms for Physician Groups 

Demographic Change Form 

HIV Attestation Form 2020

Non-Credentialed Practicioner Application 

Practitioner Enrollment Application 


Provider Resources 

Group Medical Visit Toolkit for Diabetes Care 

Molina Provider Portal

If you have not already done so, sign up for Molina’s Provider portal to check member eligibility, claims status, PCP rosters and more at your fingertips.  Please follow the instructions in this document to register for portal access.


Electronic Funds Transfer - Timely and Efficient Payment

Sign up for EFT to make the best use of your time and resources.  Please follow the instructions in this document to register for EFT payments.


LINKS to Molina Healthcare of New York Resources

Molina Member Incentives