Clinical Coverage Policies

The Molina Clinical Policies accessible on this page are specific to Molina Healthcare of Ohio Medicaid members only and can be used as a tool to guide you in your medical decisions. Note: For Medicare, MyCare Ohio, and Marketplace Clinical Policies, please visit the Molina Clinical Policy page.

Please know that these Clinical Coverage Policies do not constitute plan authorization, nor is it an explanation of benefits. Prior authorization should be obtained prior to delivery of the service.

Lightbulb icon tealTip: Using the Code LookUp Tool will provide further guidance on diagnosis or age considerations to help decide applicable criteria. Use the tool here.

Molina Clinical Policies (MCP)

All service requests not delegated to Evolent.

Evolent

Evolent performs Utilization Management services on behalf of Molina Healthcare for certain cardiology and oncology services for members ages 18 and older.

Archived Medicaid Clinical Coverage Policies can be found here.