Prior Authorizations in Nevada

Important update for providers:

Starting 2/1/26, providers must submit medical benefit PA requests through Availity provider portal, as Molina no longer accepts fax submissions. Continue to follow the current pharmacy submission processes for pharmacy benefit PA requests; do not submit these through Availity provider portal.

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. The following services do require a PA:

Emergency: Inpatient emergency admissions require PA.

Home Healthcare Services: Requires prior authorization after initial evaluation plus six (6) visits per calendar year. This includes home-based PT/OT/ST. 

Therapy: Outpatient Therapy Services: Physical, Occupational, and Speech: Requires prior authorization after initial evaluation plus 12 visits per calendar year for each specialty.  Authorization is reviewed in Units (4 units = 1 visit). 

Sleep Studies: No PA required for allowable codes when done in the home setting. Requires prior authorization if done in facility setting. 

Molina requires PA for certain services. See which services need PA with the prior authorization lookup tool. Providers can request and manage authorizations via Availity provider portal.

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.

Prior Authorization Request Form

2026 Marketplace Prior Authorization Request Form

Prior Authorization Criteria 

Real-Time Prescription Benefits Access and Onboarding Handbook 

Real-Time Prescription Benefits Information at the Point of Care 

Advanced Imaging (AI) and Transplant Authorizations

Molina requires prior authorization for advanced imaging and transplant service requests via the following fax numbers:

Advanced Imaging: (855) 714-2415

Transplant: (855) 714-2415

Medical and Radiation Oncology

Molina manages medical and radiation oncology through Evolent for members over 18 years old. Evolent contact information is as follows:

Phone: (888) 999-7713

Fax: (800) 784-6864

Medical Oncology: Option 2

Radiation Oncology: Option 3

Neonatal Intensive Care Unit (NICU) Authorizations

Molina manages NICU benefits through Progeny Health