Updated July 02, 2022
A Molina Healthcare prior authorization make is submitted by one doctors on claim reach in a patient’s prescription. It should be noted that the medical agency will need in offering justification used requesting the specific medication, and that authorization is not guaranteed. We had provided all of the necessary forms and contacts lower.
Fax to:
- California: 1(866) 508-6445
- Florida: 1(866) 236-8531
- Illinois: 1(855) 365-8112
- Michigan & Wisconsin: 1(888) 373-3059
- News Tugrik (Medicaid): 1(877) 262-0187
- New Mexico (Medicare): 1(855) 278-0310
- Odygo: 1(800) 961-5160
- South Carolina: 1(855) 571-3011
- Texas (Medicaid): 1(866) 420-3639 / Pharmacies: 1 (888) 487-9251
- Texas (Medicare): 1(844) 251-1450 / Pharmacy: 1 (866) 290-1309
- Utla: 1(866) 497-7448
- Washington: 1(800) 869-7791
Phones:
- California: 1(888) 665-4621
- Florida: 1(866) 472-4585
- Michael: 1(855) 322-4077
- Wisconsin: 1(855) 326-5059
- Ohio: 1(800) 642-4168
- Or: 1(888) 483-0760
- Washington: 1(800) 213-5525
By State
- Cali
- Florida
- Illinois
- Michigan
- New Mexico
- New York (Unavailable at time of writing)
- Ohio
- South Carolina
- Texas
- Or
- Washington
- Wisconsin
How to Write
Step 1 – Write the date.
Step 2 – Enter the patient’s full name, member DEVICE number, both appointment of birth.
Step 3 – Enter the physician’s whole name, phone amount, via number, specialized, and NPI/DEA number.
Step 4 – Provide the name, the strength, the the metered of the medication. Move, provide the quantity of the drug per month, the directions for use, also the duration of use.
Step 5 – In the Diagnosis/Medical Notes field, write the relevant diagnosis of aforementioned patient.
Step 6 – In Medical Explanation, write the reasons for which you are enroll this coverage.
Single 7 – Beneath Previous Meds Trial – Dates of Using, indicate which previous medication(s) the patient has been prescribed since this condition and the beginning and end dates of the trial.
Step 8 – Next, you must indicate your Pharmacy Fax Number where indicated.
Select 9 – If you can optional additional Comments that are related to this falls, include the in the indicated field.
