Please click on a form below to view a PDF printable version.
The files below are in PDF format ()
2020 Marketplace Drug Formulary
Wisconsin Marketplace Prior Authorization Form
Preventive health guidelines can be beneficial to the provider and his/her patients. Guidelines are based on scientific evidence, review of the medical literature, or appropriately established autho...
Preventive health guidelines can be beneficial to the provider and his/her patients. Guidelines are based on scientific evidence, review of the medical literature, or appropriately established autho...
One of the goals of Molina Healthcare Utilization Management (UM) department is to render appropriate UM decisions that are consistent with objective clinical evidence. To achieve that goal, Molina He...
For questions about any of the following areas, please select the appropriate link:Submitting Electronic: Claims, Referral Certification and Authorization1-866-409-2935Email Directly: EDI.Claims@Molin...
We use cookies on our website. By using our website, you consent to our use of cookies in accordance with our Privacy Policy.
Select Your Language
Select Your State
Submit
Please select one of the sta...
Contracted Vendor Listing of Injectable and Implantable MedicationsItems on this list will only be dispensed after prior authorization from Molina Healthcare of California. Please check your contract ...
For questions about any of the following areas, please select the appropriate link:Submitting Electronic: Claims, Referral Certification and Authorization1-866-409-2935Email Directly: EDI.Claims@Molin...
