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Claims Forms
Participating Provider Claim Dispute Form
Provider Network Forms
Provider Information Change Form
Request to Add a New Provider
Facility/HealthCare Delivery Organization (HDO)/Long Term Special Services (LTSS) Credentialing Application
Non-Participating Provider Forms
Waiver of Liability Form
Claim Appeal Request Form
Utilization Management Forms
Medicare PA Guide
Medicare PA Form
Medicare BH PA Form
Medicare Pharmacy PA Form
Behavioral Health Forms
Psychological and Neuropsychological Assessment Supplemental Form
Pharmacy Forms
Passport Advantage (HMO D-SNP)
2024 Rx Mail Order Form
2024 Coverage Determination Request Form
2024 Redetermination Form
Passport Medicare Choice Care (HMO)
2024 Rx Mail Order Form
2024 Coverage Determination Request Form
2024 Redetermination Form
CMS-0057 Prior Authorization Annual Reporting
2025 Prior Authorization Guide
Prior Authorization Lookup Tool
Kentucky Medicare Prior Authorization Annual Report 2025
H1799 Prior Authorization Report 2025
| Prior Authorization Statistics |
Molina Healthcare Inc
Percentage
|
| The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. |
91% |
| The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. |
9% |
| The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. |
46% |
| The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. |
40% |
| 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. |
NA |
| 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. |
0% |
| The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. |
89% |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. |
11% |
|
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) |
2 |
| 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) |
1 |
| 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) |
17 |
| 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) |
14 |
|
