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Provider Services Phone: (855) 838-7999
Provider Relations Email: SWHProviderRelations@molinahealthcare.com
Prior Authorization Forms
Medicare PA Guide
Medicare PA Form
Medicare BH PA Form
SNF Enhanced Auth Form
Pharmacy & Prescription Drug Forms
Online Request for Medicare Part D Prescription Drug Coverage
Online Request for Medicare Part D Redetermination
Prescription Coverage Determination Form
Redetermination Request Form
Claims
Claim Reconsideration Form
Provider Early Reversal Permission Form
Contracting/Update Forms
Provider Contract Request Form
Provider Information Update Form
Contract Copy Request Form
CAQH Provider Data Form
New Supplier Setup
New Supplier Setup Form
CMS-0057 Prior Authorization Annual Reporting
2025 Prior Authorization Guide
Prior Authorization Lookup Tool
Massachusetts Medicare Prior Authorization Annual Report 2025
H2224 Prior Authorization Report 2025
| Prior Authorization Statistics |
Molina Healthcare Inc
Percentage
|
| The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. |
94% |
| The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. |
6% |
| The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. |
49% |
| The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. |
52% |
| The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
100% |
| The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
0% |
| The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. |
95% |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. |
5% |
|
Timing |
| Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
2 |
| Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
1 |
| Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
15 |
| Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
6 |
|
