Forms and Documents

Forms and Documents

Provider Manual

2026 Marketplace Provider Manual

Download 2026 Marketplace Provider Manual

2025 Marketplace Provider Manual

Prior Authorization

2026 Marketplace Prior Authorization Guide- Q1

Provider News Bulletin - Prior Authorization and Formulary Changes - April 2026

Provider News Bulletin - Prior Authorization and Formulary Changes - January 2026

2026 Marketplace Prior Authorization Code Matrix - Q1

2025 Marketplace Prior Authorization Code Matrix - Q3

Provider News Bulletin - Prior Authorization and Formulary Changes - May 2025

Provider News Bulletin - Prior Authorization and Formulary Changes - January 2025

2025 Marketplace Prior Authorization Code Matrix - Q2

Provider News Bulletin - Prior Authorization and Formulary Changes - December 2024

2025 Marketplace Prior Authorization Code Matrix - Q1

2025 Marketplace Prior Authorization Guide - Q1

2024 Marketplace Prior Authorization Code Matrix - Q4

2024 Marketplace Prior Authorization Guide - Q4

Provider News Bulletin - Prior Authorization and Formulary Changes - August 2024

2024 Marketplace Prior Authorization Code Matrix - Q3

2024 Marketplace Prior Authorization Guide - Q3

Provider News Bulletin - Prior Authorization and Formulary Changes - May 2024

2024 Marketplace Prior Authorization Code Matrix - Q2

2024 Marketplace Prior Authorization Code Matrix - Q1

2024 Marketplace Prior Authorization Guide - Q1

Prior Authorization LookUp Tool

Gold Card Status Lookup Tool

Texas Standardized Prior Authorization Form for Prescription Drugs

Texas Standardized Prior Authorization Request Form for Healthcare Services

Behavioral Health Service Request Form

Drug Codes and Prior Authorization Requirements

Frequently Used Forms

Claims

Provider Contracting

Provider Demographics

Provider Complaints & Appeals Forms

Other Forms & Resources

Marketplace Information

CMS-0057 Prior Authorization Annual Reporting

Prior Authorization 2025

2025 Prior Authorization Guide

Prior Authorization Lookup Tool

Marketplace Prior Authorization Annual Report 2025

Prior Authorization Statistics	Molina Clinical Services, LLC Percentage
The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services.	87%
The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services.	13%
The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services.	50%
The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services.	46%
The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	53%
The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services.	57%
The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services.	90%
The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services.	10%
	Timing
Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	5
Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days)	4
Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	25
Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours)	23