Prior Authorizations

icon Medicaid/CHIP Prior Authorization Guide
icon Medicaid/CHIP Prior Authorization Annual Review Change Log
icon Medicaid/CHIP Prior Authorization Annual Review Report
icon Prior Authorization Assistance - Molina Important Contacts
icon Molina Medicaid Types Notifications
icon Medicaid and CHIP Turn Around Times for Service Determinations
icon Molina Clinical Policies
icon Essential Information
icon Molina VAS Authorization Request Form - Prescribed Shoes/Shoe Inserts

icon Prior Authorization Requests - Urgent vs. Non-Urgent


Behavioral Health and Medical
icon Medicaid/CHIP Behavioral Health and Medical Services Prior Authorization Code Matrix
icon Prior Authorization Code Matrices Diagnosis Code Addendum
icon Texas Standardized Prior Authorization Request Form for Healthcare Services
icon Behavioral Health Service Request Form



Pharmacy and Outpatient Drug Services

icon Medicaid Pharmacy Prior Authorizations
icon Medicaid Prior Authorization Code Matrix for Outpatient Drug Services
icon Texas Standardized Prior Authorization Form for Prescription Drugs


 Provider News Bulletins
 icon Provider News Bulletin Prior Authorization Code Matrix - May 2022 
icon Provider News Bulletin Prior Authorization Code Matrix - March 2022 

Archived Provider News Bulletins
icon Provider News Bulletin Prior Authorization Code Matrix - November 2021
icon Provider News Bulletin Prior Authorization Code Matrix - September 2021
icon Provider News Bulletin Prior Authorization Code Matrix - May 2021
icon Provider News Bulletin - Essential Information - April 2021 
icon Provider News Bulletin Prior Authorization Code Matrix- February 2021
icon Provider News Bulletin Prior Authorization Code Matrix - January 2021
icon Provider News Bulletin Prior Authorization Code Matrix - August 2020 -V2
icon Provider News Bulletin Prior Authorization Code Matrix - August 2020
icon Provider News Bulletin Prior Authorization Code Matrix - May 2020
icon Provider News Bulletin Prior Authorization Code Matrix - March 2020
icon Provider News Bulletin Prior Authorization Code Matrix - January 2020
icon Provider News Bulletin Prior Authorization Code Matrix - November 2019
icon Provider News Bulletin Prior Authorization Code Matrix - January 2020 Updates

 

CMS-0057 Prior Authorization Annual Reporting

download arrow button  2025 Prior Authorization Guide

download arrow button  Prior Authorization Lookup Tool

STAR+PLUS Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 94%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 6%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 65%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 69%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 48%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 59%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 86%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 14%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 52
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 24

 

CHIP RSA Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 85%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 15%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 76%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 100%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 65%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 76%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 93%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 7%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 45
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 26

STAR Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 83%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 17%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 54%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 48%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 60%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 77%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 91%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 9%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 44
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 24

 

CHIP PERINATE RSA AT OR BELOW 185% Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 95%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 5%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 100%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 67%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 81%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 91%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 93%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 8%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 53
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 37

 

CHIP PERINATE MHT AT OR BELOW 185% Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 96%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 4%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 42%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 67%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 88%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 12
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 59
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 24

 

CHIP PERINATE MHT 186% TO 200% Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 100%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 0%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. NA
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) NA
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) NA

 

CHIP Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 83%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 17%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 78%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 50%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 60%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 76%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 89%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 11%
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 3
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 2
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 47
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 25

CHIP PERINATE RSA 186% TO 200% Medicaid Prior Authorization Report 2025


Prior Authorization Statistics
Molina Healthcare Inc
Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 67%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 33%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. NA
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. NA
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. NA
Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 1
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) NA
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) NA


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