What are Prior Authorizations?
Prior authorization is when your provider gets approval from Molina MyCare Ohio Medicaid 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 you the service.
Molina MyCare Ohio Medicaid does not require prior authorization for all services. It is not required for a visit to your 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 MyCare Ohio Medicaid request the services they would like you to receive. Molina MyCare Ohio Medicaid will review the request and let the provider know if the service is approved.
Only your provider can request a prior authorization to Molina MyCare Ohio Medicaid. You cannot request one. This is done to make sure that you get the right care.
You need a prior authorization to make sure the care and services you get are medically necessary. Here are some services that may need a prior authorization:
- Home health care
- Physical therapy
- Wheelchairs and walkers
Reconsideration
If a prior authorization request is denied, your provider can ask us to review the request again. This is called a reconsideration. Your provider has up to 30 days to ask for this.
Appeal
If a prior authorization request is denied and the reconsideration is denied, your provider can submit an appeal. Learn more about the appeal process.
Services that Need Prior Authorization
View your Member Handbook for a list of services that need prior authorization. View recent changes to this list.
Questions
If you have questions, call Member Services at (855) 687-7862 (TTY 711), Monday to Friday, 8 a.m. to 8 p.m. local time. If the office is closed, you can leave a message. A Member Services representative will get back with you.