Authorizations

  • Prior Authorization

    Prior authorization is required for some services through MCC’s Utilization Management department, which is available 24 hours a day, 7 days a week. Providers are expected to submit a pre-service authorization request prior to providing the service or care. Payment will be denied for any services that require an authorization but were not prior authorized.

    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.

    Prior Authorization Request Forms

          

    Contact Customer Care with questions.

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

     

    Fax prior authorization forms to:

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

     

    Please be sure to include all required supporting documentation.

    Our Care Coordinators and health guides work collaboratively in coordinating care with members and their PCP to ensure that all care and services are integrated into the member’s comprehensive treatment plan. We may allow a standing authorization to be approved for members with chronic or disabling conditions. Providers should specifically request these authorizations when working with MCC case and disease managers on care plans for their patients.

    Decisions on routine prior authorizations will be rendered within fourteen calendar days from the date of receipt of the request. Decisions on expedited prior authorization requests will be rendered within 72 hours from the date we receive the request if we determine that the request qualifies for expedited consideration. We will notify you if the request will not be considered as an expedited request. We base our decisions for approved services on appropriateness of care and service and existence of coverage.