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Members

Prior Authorizations

What are Prior Authorizations?
Prior authorization is when your provider gets approval from Molina Healthcare to provide you a service. It is needed before you can get certain services or drugs. If prior authorization is needed for a certain service, your provider must get it before giving your child the service.

Molina Healthcare does not require prior authorization for all services. It is not required for your child’s visit to his or her primary care provider, going to the emergency room or for many other covered services.

Review Process
Many services are covered and do not need prior authorization. However, some services do need one. For a prior authorization, a provider must contact Molina Healthcare to request the services he or she would like your child to receive. Molina Healthcare will review the request and let the provider know if the service is approved.

Only your provider can request a prior authorization to Molina Healthcare. You cannot request one. This is done to make sure that your child gets the right care.

You need a prior authorization to make sure that the care and services your child receives are medically necessary. Here are some services your child may need that require a prior authorization:

 

  • Home health care
  • Physical therapy
  • Wheelchairs and walkers

 

Reconsideration
If a prior authorization request is denied, your child’s provider can ask us to review the request again. This is called a reconsideration. Your child’s provider has up to 30 days to ask for this.

Appeal
If a prior authorization request is denied and the reconsideration is denied, your child’s provider can submit an appeal. Learn more about the appeal process.

Services that Need Prior Authorization

Click here to view the list of services that need prior authorization. You can also learn more in your Member Handbook. To view recent changes to this list, click here

Questions

If you have questions, call Member Services at (800) 642-4168 or for hearing impaired, call TTY/Ohio Relay (800) 750-0750 or 711 between 7:00 a.m. and 7:00 p.m. Monday through Friday. If the office is closed, you can leave a message. A Member Services representative will get back with you. ​​​​​

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This information is for Doctors and
Health Care Professionals only.

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