Important Reminder

This is an important reminder that when collecting a paper enrollment form submitted and signed by the beneficiary, always submit the original signed enrollment form via fax.

Please do not submit an electronic application through any electronic submission method (Connecture/DRX, Sunfire, etc.), in place of the paper application. Dual submission or replacing the original form with a digital entry is a violation of CMS compliance guidelines.

You will now see the following direction in the Connecture/DRX application, reminding you that paper applications should be faxed in. Please review the fax cover sheet for instructions on faxing your applications, including the Fax2Mail address. It may be found here on the Molina Agent Center.