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  • Molina Centennial Prior Authorization Form

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Care FAX: (505) 213-0240 UNM FAX: (505) 213-0149 Phone: (505) 923-5757, option 4 Routine Urgent or Expedited Initial Determination For a Prior Authorization request to be considered Urgent or Expedited, the request must include a provider s order stating that waiting for a decision under a standard timeframe could endanger the member s life, health, or ability to regain maximum functionality or would cause serious pain. Provider s signature below is an attestation that this.

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You may also fax in a prior authorization at 800-391-6437.

For additional questions regarding Utilization Management and/or Prior Authorizations, please call 888-483-0760 or email the UM team at MHUTPriorAuthorization@Molinahealthcare.com.

If you have any questions, call Provider Services at (855) 322-4082. For the latest trainings and resources on integrated care and other best practices please click here.

By fax. Complete the Texas standard prior authorization request form (PDF). Then, fax the form to 1-866-835-9589.

The requested clinical should be faxed to Medical Management, using the appropriate fax number for the service for which authorization is requested. Medicaid Prior Authorization Fax Numbers: Physical Health: 1-800-690-7030. Behavioral Health: 866-570-7517.

Complete / Review information, sign, and date. Fax signed forms to Molina Pharmacy Prior Authorization Department at 1-888-487-9251.

Molina Healthcare's Apple Health (Medicaid) Programs offer free or low-cost medical coverage for children and adults with lower income who are eligible for Medicaid.

Molina Healthcare has a full-time Medical Director available to discuss medical necessity decisions with the requesting physician at (855) 322-4080. Phone: (888) 275-8750/TTY: 711 Members who speak Spanish can press 1 at the IVR (Interactive Voice Response) prompt.

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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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