Molina Healthcare of Texas, Prior Authorization

Molina Healthcare of Texas, prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Molina’s Texas provider manual says prior authorization requests may be submitted through the Provider Portal, by fax, by phone, or by mail. Participating providers are encouraged to use the portal. The manual states that additional documentation may be needed before a request can be processed. Fax routes vary by authorization type, including Medicaid/CHIP, Nursing Facilities, MMP, LTSS, radiology, pharmacy, behavioral health, and transplant.
• Fax numbers vary by authorization category.
• The manual indicates additional documentation may be required, but does not list one universal documentation set for all prior auth types.
• Some authorization workflows differ by line of business (Medicaid/CHIP, MMP, LTSS, behavioral health, radiology, pharmacy, transplant).

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• Provider Portal

• Fax

• Phone

• Mail

• Submission resource 1

• Submission resource 2

Information commonly required

• Prior Authorization request form
• Supporting medical documentation
• Authorization type-specific information
• Referring provider information
• Referred-to provider information
• Rendering facility information
• Supporting information

Turnaround notes and caveats

• The provider portal allows checking authorization status and receiving status-change notifications.
• The sources reviewed did not provide a single Texas-specific standard turnaround time for all prior authorization requests.
• Fax numbers vary by authorization category.
• The manual indicates additional documentation may be required, but does not list one universal documentation set for all prior auth types.
• Some authorization workflows differ by line of business (Medicaid/CHIP, MMP, LTSS, behavioral health, radiology, pharmacy, transplant).

Provider resources

• Texas Provider Home (official)
• Texas Provider Manual Home (official)
• Texas Provider Manual PDF (official)
• Texas Provider Contact Information (official)
• Texas Provider Portal / Availity Essentials entry (official)

Sources