Prior Authorizations
Providers can find details about Molina’s prior authorization (PA) process, methods for submitting requests, procedures for denials and peer-to-peer reviews, as well as how to access forms and contact our team.
Prior authorization guides
Medicaid prior authorization/preservice review guide
Home Health and Outpatient Therapy PA Form
FIDE D-SNP prior authorization/preservice review guide
Marketplace prior authorization/preservice review guide
Medicare prior authorization/preservice review guide
Important update for providers
Providers must submit medical benefit PA requests through Availity Essentials, as Molina no longer accepts fax submissions, with the exception of Pharmacy and delegated UM vendors. Continue to follow the current pharmacy submission processes for pharmacy benefit PA requests; do not submit these through Availity Essentials.
Clinical documentation
All PA requests should include pertinent clinical documentation supporting the request.
Service prior authorizations
Office visits to participating (PAR) providers and referrals to network specialists do not need Prior Authorization (PA). Emergency services also do not require authorization.
Providers can request and manage authorizations via Availity Essentials.
Pharmacy prior authorizations
Molina manages prescription drug benefits through our pharmacy benefit manager partner. Outpatient drugs on Molina's Formulary are covered, while medications not on the PDL need prior authorization for approval.