Secure email received from: Evelin.Suazo@molinahealthcare.com  Subject: [SEND SECURE] Molina Contracting PDL 187874    PDL# 187874  Group: Gulf Coast Imaging & Associates, LLC  Tax ID: 820701672     Good morning,  This is Evelin your Contract Coordinator at Molina. I received your contract request to become an in-network provider with Molina but, before I can send the contract please kindly provide me with the following information:  Authorized Representative: Name of the person that will sign the contract:  Title:  Email address:     Please complete the attached forms once completed please sent them back to me. Thank you     Complete the Sample Claim Form ( Number: 25, 31, 32, and 33)    Complete the Molina Data Collection Form    Complete the Molina TAHP             Send all required information within 30 calendar days to:     Email: evelin.suazo@MolinaHealthcare.com     Effective April 1, 2018 all providers must meet the HHS defined credentialing standards for all providers.  Additionally, for the PSA the provider must meet Molina’s credentialing criteria.  Credentialing is now handled through the Texas Association of Health Plans (TAHP) Credentialing Verification Office (CVO).  This is a new process so that providers can enter their credentialing information once into the CVO system and it will be sent to all 5 Medicaid MCOs.     If not yet registered for Availity, go to www.Availity.com, click register in the top right of the page, then follow the organization registration process.  Once your registration is approved, you can proceed to the next step.                We look forward to having you as a part of our network and encourage you to visit www.molinahealthcare.com to learn more about us.  My contact information is listed below should you have any questions or concerns.     Thank you,   Evelin Suazo  Associate Specialist,Provider Contracts  Molina Healthcare of Texas, Inc.  evelin.suazo@molinahealthcare.com  1660 Westridge Circle N  Irving, Texas, 75038  281-675-5376