Forms and Documents

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Provider Manual

2023 Marketplace Provider Manual

Download 2023 Marketplace Provider Manual

Prior Authorization

Prior Authorization LookUp Tool

Download Prior Authorization LookUp Tool

Authorization Reconsideration Form

Download Authorization Reconsideration Form

Molina Healthcare Prior Authorization Request Form and Instructions

Download Molina Healthcare Prior Authorization Request Form and Instructions

Prior Authorization (PA) Code List – Effective 7/1/2023

Download Prior Authorization (PA) Code List – Effective 7/1/2023

Prior Authorization (PA) Code List – Effective 4/1/2023

Download Prior Authorization (PA) Code List – Effective 4/1/2023

Prior Authorization (PA) Code List – Effective 1/16/2023

Download Prior Authorization (PA) Code List – Effective 1/16/2023

Prior Authorization (PA) Code List – Effective 1/1/2023 to 1/15/2023

Download Prior Authorization (PA) Code List – Effective 1/1/2023 to 1/15/2023

PA Code List Archive

Download PA Code List Archive

Ohio Urine Drug Screen Prior Authorization (PA) Request Form

Download Ohio Urine Drug Screen Prior Authorization (PA) Request Form

Observation Level of Care FAQ

Download Observation Level of Care FAQ

Pain Management Procedures

Download Pain Management Procedures

Frequently Used Forms

Toolkits and Resources

Endometrial Ablation Procedures

Download Endometrial Ablation Procedures

Availity Essentials Overview

Download Availity Essentials Overview

Availity Payer Spaces Single Sign On Features

Download Availity Payer Spaces Single Sign On Features