Authorizations

  • Utilization Management

    MCC’s Utilization Management department performs many functions including but not limited to concurrent review, prior authorization, discharge planning assistance and retrospective review. Our Utilization Management program’s goal is to optimize the use of healthcare resources for our members. Services provided are not less than the amount, duration, and scope for the same services delivered to fee-for-service Medicaid members. Medically necessary services are no more restrictive than used in the DMAS defined program. MCC supports continuity and coordination of care for physical, dental, and behavioral health providers. Our members’ health is always our number one concern.

    MCC makes the utilization management criteria available in writing, by mail or fax:

    Mail:
    Molina Complete Care
    Attn: Utilization Management Department
    3829 Gaskins Road
    Glen Allen, VA 23233

    Fax:
    CCC Plus: (866) 210-1523
    Medallion 4.0: (855) 769-2116
    Behavioral health: (855) 339-8179

    MCC providers should call our toll-free number with any utilization management questions. We’re available Monday through Friday from 8 a.m. to 6 p.m. local time. Providers can leave voice mail messages after business hours. An on-call nurse is available after hours for urgent concerns.

    • CCC Plus: (800) 424-4524
    • Medallion 4.0: (800) 424-4518



    Molina Complete Care (MCC) and Availity are proud partners in bringing you a better way to submit service authorization requests. We are requesting all inpatient authorization requests now be submitted through our new Availity portal. 

    If you need training, please visit our Provider Materials page to view our recorded training about the Availity provider authorization portal. 

    Sign up for the Availity provider portal if you are not yet registered: 
    1. Go to www.Availity.com
    2. Click “Register” in the upper right-hand corner 
    3. Follow the prompts to register your account 

    Call Availity at 1-800-828-4548 if you have any issues registering. 

    If you are already submitting requests via the portal please complete the following steps to submit for a concurrent review:
    1. Go to “Auth Inquiry” OR “Clinical Update.” 
    2. Enter in the previous authorization number. 
    3. Attach continued stay clinical documentation. Your pending request for concurrent review will then be routed to the Utilization Management (UM) team.