Passport by Molina Healthcare Medicaid Clinical Policies for Kentucky
Access the policies and guidelines that Molina uses to make medical necessity decisions. The policies below are specific to Passport by Molina Healthcare in Kentucky.
For Molina Policies, check here.
Passport by Molina Healthcare (Passport) follows the most current edition of MCG, a nationally recognized set of guidelines. Passport may employ the Molina Clinical Policies. if the MCG guidelines are insufficient. Please note, these policies do not constitute plan authorization, an explanation of benefits, or a guarantee of payment.
Passport Clinical Policy Links
Molina Dental Services Policy Links
Oncology & Radiology
Passport partners with New Century Health to administer cardiology and oncology services for members age 18+. For clinical policies related to cardiology and oncology, please visit New Century’s website www.NewCenturyHealth.com or click the following link: Compliance and Regulatory Information - New Century Health. Clinical policies are also housed within the provider portal at my.newcenturyhealth.com.
Pharmacy
MedImpact administers pharmacy benefits for Kentucky Medicaid Members. For information regarding Kentucky Medicaid Single PDL Prior Authorization Criteria please click here.