Prior Authorizations in Washington
Providers can find details about Molina’s prior authorization (PA) process, methods for submitting requests, procedures for denials and peer-to-peer reviews, as well as how to access forms and contact our team.
Medicaid prior authorization guide
Important update for providers:
Providers should submit medical benefit PA requests through the Availity Provider Portal whenever possible. Continue to follow the current pharmacy submission processes for pharmacy benefit PA requests; do not submit these through the Availity Provider Portal.
Service Prior Authorizations
Office visits to participating (PAR) providers and referrals to network specialists do not need Prior Authorization (PA). Emergency services also do not require authorization.
Molina requires PA for certain services. See which services need PA with the prior authorization lookup tool. Providers can request and manage authorizations via Availity Essentials.
Pharmacy Prior Authorizations
Molina manages prescription drug benefits through CVS/Caremark. Outpatient drugs on Molina's preferred drug list (PDL) are covered, while medications not on the PDL need prior authorization for approval.