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We understand that you may have additional questions during the transition to Molina and are happy to help you get the answers you need. The information below applies to dates of service on or before 6/30/2020. For dates of service on or after 7/1/2020, please contact Molina Healthcare at www.molinahealthcare.com. If you are uncertain, please call 888.638.7149 and we can help direct your question.
YourCare is committed to conducting its business with integrity and in accordance with all federal, state, and local laws to which its business activities are subject to. The Compliance department ensures that the entire YourCare organization, including employees and business partners, maintain the highest ethical and legal standards in our day-to-day activities and responsibilities.
Thank you for your interest in the compliance department. For questions, please contact:
To report suspected fraud, waste, or abuse call 844.654.3977. You may also send an email to SIU@YourCareHealthPlan.com. (You may remain anonymous).
Other Helpful Links:
YourCare adopts clinical criteria for utilization review decisions (or coverage determinations) that is based on credible scientific evidence and is recognized by the medical community. Guidelines take into account physician society recommendations, the views of the physicians practicing in relevant clinical areas, the needs of the members in consultation with participating providers, and other relevant factors to the extent practicable.
Criteria can be requested by calling 1 (800) 683-3781 or submitting a written request to 1 (888) 273-8296. Requests may also be submitted in writing to P.O. Box 240, Pittsford, N.Y. 14534. Once received, criteria will be provided verbally and/or in writing, whichever is preferred.