Get Molina Healthcare Medication Prior Authorization/exceptions Request Form 2019-2025
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How to fill out the Molina Healthcare Medication Prior Authorization/Exceptions Request Form online
Navigating the Molina Healthcare Medication Prior Authorization/Exceptions Request Form can seem daunting, but this guide is designed to assist you in completing it accurately and efficiently. By following these step-by-step instructions, you can ensure that your submission is complete and meets all necessary requirements.
Follow the steps to successfully complete the form online.
- Press the 'Get Form' button to access the Medication Prior Authorization/Exceptions Request Form and open it in your chosen editor.
- Fill in today's date at the top of the form.
- In the member information section, provide the last name, first name, ID number, and date of birth of the member requesting medication.
- Complete the provider information section by entering the name, specialty, NPI number, phone number, and fax number of the referring provider.
- If applicable, fill in the hospital discharge date and specify the review type as either initial review or reauthorization.
- Indicate the point of contact or case manager's name along with their phone number.
- In the medication requested section, provide the medication name, strength, directions for use, and the quantity needed.
- Input the ICD-10 code or diagnosis description relevant to the medication request.
- Document any previous formulary medication trials and failures, including length of treatment, outcomes, and supporting dates.
- Compile and attach recent clinical chart notes that demonstrate the medical necessity of the request, as well as a copy of the prescription.
- Review all information entered on the form to ensure it is complete and legible, as incomplete submissions may be returned.
- Once you have finished filling out the form, save your changes, and choose to download, print, or share the form as needed.
Complete your Molina Healthcare Medication Prior Authorization/Exceptions Request Form online today to ensure timely processing.
Yes, it is possible to get some medications without prior authorization, but you should proceed with caution. The lack of prior authorization might lead to denied claims by Molina Healthcare, resulting in unexpected costs. To avoid these issues, it is advisable to utilize the Molina Healthcare Medication Prior Authorization/Exceptions Request Form. This form protects you from potential complications and ensures seamless access to your medications.
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