Hdo application 2026

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4.8 out of 5

132 votes

The document is an application for initial credentialing or recredentialing with Molina Healthcare, Inc. It outlines the requirements and instructions for organizations seeking to apply, including necessary documentation, completion guidelines, and information about multiple locations. The application must be filled out completely, and incomplete submissions will be returned. Additionally, it includes sections for organizational information, insurance coverage, physical location details, accreditation status, and an attestation section where the authorized agent certifies the accuracy of the provided information.

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Click ‘Get Form’ to open the HDO application in the editor.
Begin by filling out the 'Organization Information' section. Provide the legal name, DBA name, and contact details. Ensure all fields are completed accurately.
Next, move to the 'Current Insurance Coverage' section. Attach a copy of your liability insurance face sheet if applicable, and fill in policy details as required.
For each practice location, complete sections 3 and 4. Include specific information such as Medicare certification status and any additional credentials for each location.
Finally, review the 'Attestation and Release of Information' section. Ensure you understand the consent requirements before signing and dating the application.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (132 Votes)
2018	4.3 Satisfied (54 Votes)
2014	4.3 Satisfied (187 Votes)
2013	4 Satisfied (33 Votes)
2011	4.4 Satisfied (169 Votes)

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