Molina Prior Authorization Process
Overview
Molina Healthcare operates Medicaid and Medicare Advantage plans across 13 states, managing both traditional and specialized managed care products. Molina processes prior authorization requests within 1-5 business days for standard requests and 24 hours for expedited cases. Authorization requirements vary significantly by state and plan type. Medicaid plans typically require authorization for specialty referrals, imaging, and durable medical equipment; Medicare Advantage plans follow federal Medicare guidelines with additional state-specific restrictions.
Key Requirements
- Identify Member's State Plan: Molina operates Medicaid and Medicare Advantage plans across 13 states. Authorization requirements vary by state and plan. Verify the member's specific plan and state on their ID card.
- Confirm Authorization Need: Not all services require prior authorization. Check Molina's provider portal or state Medicaid/Medicare website to confirm authorization requirements before submission.
- Required Documentation: Include diagnosis codes, procedure codes, treatment plan, medical necessity justification, and date of service. Incomplete submissions delay approval.
- Submission Method: Most Molina plans accept online portal submissions. Phone and fax submissions are available; verify contact information through Molina's provider website.
Approval Timeframes & States
Molina processes standard authorizations within 1-5 business days. Expedited requests receive 24-hour approval. Concurrent authorization (submitted during admission) is resolved within 24 hours. Emergency services are approved retrospectively after treatment. Molina operates in California, Florida, Illinois, Louisiana, Michigan, Mississippi, Missouri, New Mexico, Ohio, South Carolina, Texas, Utah, and Washington. State-specific Medicaid rules define additional authorization requirements beyond Molina's standard processes.
Submission Methods by State
| Method | Timeframe | Availability |
|---|---|---|
| Online Provider Portal | 1-5 business days | Most states |
| Phone Authorization Line | Same day or next day | All states |
| Fax Submission | 1-5 business days | All states |
| Expedited/Concurrent | 24 hours | All states |
Common Denial Reasons
Missing prior authorization before service delivery results in automatic denial. Incomplete clinical documentation delays approval and increases denial risk. Services outside plan coverage (experimental treatments, non-covered procedures) are denied based on plan design. Incorrect member eligibility on date of service causes eligibility-based denials. Verify authorization requirements, complete documentation, and member eligibility before service delivery.
Common Questions
How long does Molina take to approve prior authorization?
Standard: 1-5 business days. Expedited: 24 hours. Concurrent (during admission): 24 hours. Emergency services: approved retrospectively after treatment.
Which services require Molina prior authorization?
Specialty referrals, imaging (MRI, CT, PET), inpatient admissions, surgeries, and durable medical equipment typically require authorization. Check your state plan's specific requirements.
What happens if I provide care without authorization?
Non-emergency services delivered without prior authorization are denied and become patient financial liability. Always obtain authorization confirmation before service delivery.
Altair checks Molina Healthcare requirements before submission . flagging missing authorizations and coding mismatches in real time. See how Altair works.
This reference is for informational purposes. Payer policies change frequently. Always verify against Molina Healthcare's current provider documentation. Last updated: 2026-03-16.