Molina Healthcare Clinical Policies for Ohio
Access the policies and guidelines that Molina uses to make medical necessity decisions.
For Molina Policies, check here.
The site includes Molina Clinical Policies (MCPs), which are used by providers as well as Molina’s Medical Directors and internal reviewers to inform or guide medical necessity determinations. MCP are not medical advice, and treating providers make treatment decisions on an individualized basis. The website ensures that Providers have access to the most current MCPs. Routine updates are made following approval by the Molina Clinical Policy Committee. When changes are made they are posted in the “Clinical Policy Updates” link below.
Ohio Specific Clinical Policies
In addition to the Molina Clinical Policies linked above, please be sure to review the Ohio-specific policies below.
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 are they an explanation of benefits. Prior authorization should be obtained prior to delivery of the service. Get more information on Molina’s prior authorization policies.
Tip: Using the Code Lookup Tool will provide further guidance on diagnosis or age considerations to help decide applicable criteria.