Forms and Documents

Forms and Documents

Provider Manual

2026 Marketplace Provider Manual

2025 Marketplace Provider Manual

2024 Marketplace Provider Manual

2023 Marketplace Provider Manual

Prior Authorization

Prior Authorization LookUp Tool

2026 Q1 Marketplace Prior Authorization Code Matrix

2025 Q3 Marketplace Prior Authorization Code Matrix

2025 Q1 Marketplace Prior Authorization Code Matrix

2025 Q2 Marketplace Prior Authorization Code Matrix

2024 Q1 Marketplace Prior Authorization Code Matrix

2024 Q2 Marketplace Prior Authorization Code Matrix

2024 Q3 Marketplace Prior Authorization Code Matrix

2026 UT Marketplace Prior Authorization Guide & Request Form

2025 UT Marketplace Prior Authorization Guide & Request Form

2024 Q1 UT Marketplace Prior Authorization Guide & Request Form

2024 Q2 UT Marketplace Prior Authorization Guide Request Form

2024 Q3 UT Marketplace Prior Authorization Guide Request Form

Medical Benefit (HCPCS/J-Code) Drug Prior Authorization Request Form

Request Prior Authorization for Medication form (Marketplace)

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

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Claims

Provider Contracting and Credentialing

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