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New Accounts - Provider | Member

Illinois Medicaid

Molina Illinois Medicaid Dental Program

As of July 1, 2013, Avesis Third Party Administrators, Inc. will be the dental program administrator for Molina Illinois Medicaid, a contracted managed care organization with Molina Healthcare. Avesis will be administering services for eligible Illinois Medicaid members enrolled in the Molina Plan. The coverage region will consist of the following counties: Stark, Peoria, Knox, Tazewell, McLean, Ford, Menard, Logan, DeWitt, Piatt, Champaign, Vermillion, Sangamon, Macon, Christian, Madison, Clinton & St. Clair in the East St. Louis area.

If you are interested in participating in the Medicaid program please complete the Credentialing and Contracting paperwork by clicking here . If you have any questions please contact one of our Provider Services Representatives at 866-857-8124.

Please click here to access Molina Illinois Medicaid Dental Program Provider Forms.

Providers wanting to participate in the Molina Illinois Medicaid program administered by Avesis must have a NPI number as well as an active Illinois Medicaid ID number. To apply for a NPI number click here; to apply for a Illinois Medicaid ID number click here.

Send Completed Materials by mail to Provider Services:

Mail To:

Avesis Third Party Administrators, Inc.
Attn: Molina IL Network Development
10324 South Dolfield Road
Owings Mills, MD 21117