On this page, 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.
Service prior authorizations
Office visits to participating (PAR) providers and referrals to network specialists do not need PA. Emergency services also do not require authorization.
Molina requires PA for certain services. See which services need PA with the Prior Authorization Look Up tool. Providers can request and manage authorizations via Availity.
Pharmacy prior authorizations
Molina manages prescription drug benefits through CVS/Caremark. Outpatient drugs on Molina's Preferred Drug List (PDL) are covered, while medications not on the PDL need prior authorization for approval.