Get Submitting Requests For Prior Authorization - Molina Healthcare Inc.

Navigating the Submitting Requests For Prior Authorization form for Molina Healthcare Inc. can seem daunting, but understanding each component can streamline the process. This guide provides clear, step-by-step instructions to help users efficiently complete the form online.

Follow the steps to successfully complete the form.

1. Use the ‘Get Form’ button to acquire the form and access it in the online setup.
2. Begin by entering the member information. Fill in the member's name and ID number accurately. This ensures their records are correctly matched.
3. Indicate the service type by checking the appropriate box. Select 'Elective/Routine' or 'Expedited/Urgent' based on the urgency of the request. If you choose 'Urgent', please ensure it meets the defined criteria.
4. Provide detailed information on the service being requested. This includes selecting 'Inpatient' or 'Outpatient' and specifying the exact service needed.
5. Enter the diagnosis code and a brief description. It is essential for clarifying the medical necessity of the requested procedure.
6. Include the CPT/HCPC code relevant to the service along with a description, as these codes help in identifying procedures accurately.
7. Indicate the number of visits requested or the dosage for specialty medications, ensuring to include relevant units.
8. Document the expected date(s) of service to keep track of scheduling.
9. Attach any needed clinical notes or supporting documentation which can strengthen the authorization request.
10. Complete the provider information section with the requesting provider’s name, facility providing the service, a contact person from the requesting office, and their phone number.
11. After reviewing all the entered information for accuracy, save changes to your document. You can then download, print, or share the form as needed.

Start filling out your document online today for a smoother authorization process.