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  • Wa Molina Healthcare Behavioral Health Authorization/notification Form 2019

Get Wa Molina Healthcare Behavioral Health Authorization/notification Form 2019-2025

Ketplace Request Type: Initial Date of Request: Concurrent Admit/Start Date of Services: Honor Authorization (Medicaid suspended due to incarceration) Member Name: DOB: Member ID#: Member Phone: Service is: Elective/Routine Expedited/Urgent* *A service request designation is defined as Expedited/Urgent when the treatment requested is required to prevent serious deterioration of the member s health, or if not received could jeopardize the member s ability to r.

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Related content

2020 Behavioral Health Provider Services Reference...
Jun 30, 2020 — PRIOR AUTHORIZATION REQUIRED? ... require notification only...
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Molina Healthcare, Inc., PA Code Matrix...
Aug 1, 2015 — Behavioral Health “Day Treatment” is not a covered benefit for TX...
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The phone number is (888) 275-8750 (TTY 711) / (866) 648-3537 (Spanish).

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

As always, you may contact Molina Healthcare of Washington by calling 855-322-4082.

Molina's BHSO health plan is designed to provide Washington Apple Health (Medicaid) Fee-for-service members with mental health and substance use disorder treatment services. Together with our behavioral health providers, our goal is to help keep you well. Learn more.

Molina's BHSO health plan is designed to provide Washington Apple Health (Medicaid) Fee-for-service members with mental health and substance use disorder treatment services. Together with our behavioral health providers, our goal is to help keep you well. Learn more.

Call Member Services at (844) 809-8438, TTY/TDD: 711.

Contact Information Provider ServicesPhone (855) 322-4082 Fax (425) 424-1172 / (877) 814-0342ClaimsPhone (855) 322-4082 PO Box 22612 Long Beach, CA 90801Member ServicesPhone (800) 869-7165 Fax (800) 816-3778Mailing AddressMolina Healthcare of Washington PO Box 4004 Bothell, WA 98041-40041 more row • 26 Jan 2023

Molina accepted locally for Medicaid as Community Health Plan of Washington departs. As of the start of the new year, Community Health Plan of Washington(CHPW) is no longer operating in Grays Harbor County. In response to their departure, GHCH says that they have partnered with Molina as of January 1st.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232