Molina Prior Authorization List 2023 (2024)

FAQs

Does Michigan Medicaid require prior authorization? ›

Prior authorization requirements also apply to secondary coverage. The following services always require prior authorization: Inpatient services (elective and urgent) Codes not on the Michigan Medicaid Fee Schedule.

Molina Healthcare's Apple Health (Medicaid) Programs offer free or low-cost medical coverage for children and adults who meet the eligibility requirements for Apple Health (Medicaid).

Submitting clinical notes along with the PA is recommended to receive a timely and accurate decision. If a PA is required for a requested service, please fax your authorization request to Molina at (833) 322-1061.

If you have any questions, call Provider Services at (855) 322-4082.

If the proposed treatment doesn't meet the threshold for being medically necessary, it won't be reimbursed by the payer. If a provider's office submits a wrong billing code, misspells a name or makes another clerical error, this can result in a denied PA request.

If prior authorization is required and is not obtained, the health plan can reject the claim—even if the procedure was medically necessary and would otherwise have been covered.

All of Molina Healthcare, Inc.'s health plan subsidiaries are owned by Molina Healthcare, Inc., a Delaware corporation (“MHI”).

Molina Healthcare, Inc. , a FORTUNE 500 company (currently ranked 125), provides managed healthcare services under the Medicaid and Medicare programs and through the state insurance marketplaces. Molina Healthcare served approximately 5.2 million members as of September 30, 2022 , located across 19 states.

Apple Health (Medicaid)

(“Molina”) complies with applicable Federal and Washington State civil rights laws that relate to health care services.

Box 23 - TITLE: Prior Authorization Number (this field is also used for CLIA numbers) • INSTRUCTIONS: Enter any of the following: prior authorization number, referral number, or Clinical Laboratory Improvement Amendments (CLIA) number, as assigned by the payer for the current service. system.

What is the payer ID number for Molina Healthcare of Washington? ›

Claims submitted electronically must use EDI payor ID number – 38336.

We work with SSI Claimsnet for all EDI transactions. When submitting your 837 (I & P) files, please use our Payer ID: MLNIA. Molina Healthcare offers a direct submit/web-based claims option through Availity. This functionality is available via the provider portal on our website.

Molina Healthcare Apple Health (Medicaid) provides quality free or low-cost health care for your family. Find out more about your health plan, what's covered and the many programs we offer you and your family.

You can get women's health care services from any provider who has a contract with Molina Healthcare. You do not need a referral from your primary care provider (PCP).

Washington Apple Health is the name for Medicaid in Washington State. Your provider or the receptionist may call it Medicaid.

To qualify for Medicaid in Michigan, your household income must be at or below 133% of the federal poverty level. Today's income limits for Michigan Medicaid are roughly $18,000 for an individual, $24,000 for a couple, or $36,000 for a family of four.

Medicare Advantage (MA) plans also often require prior authorization to see specialists, get out-of-network care, get non-emergency hospital care, and more. Each MA plan has different requirements, so MA enrollees should contact their plan to ask when/if prior authorization is needed.

Prior authorization—sometimes called preauthorization or precertification—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

Your insurance company may require prior authorization before covering certain prescriptions. This is to ensure that the medication is appropriate for your treatment. It also helps to make sure it's the most cost-effective option.