Prior Authorizations

icon Medicaid/CHIP Prior Authorization Guide
icon Medicaid/CHIP Prior Authorization Annual Review Change Log
icon Medicaid/CHIP Prior Authorization Annual Review Report
icon Prior Authorization Assistance - Molina Important Contacts
icon Molina Medicaid Types Notifications
icon Medicaid and CHIP Turn Around Times for Service Determinations
icon Molina Clinical Policies
icon Essential Information
icon Molina VAS Authorization Request Form - Prescribed Shoes/Shoe Inserts


Behavioral Health and Medical
icon Medicaid/CHIP Behavioral Health and Medical Services Prior Authorization Code Matrix
icon Prior Authorization Code Matrices Diagnosis Code Addendum
icon Texas Standardized Prior Authorization Request Form for Healthcare Services
icon Behavioral Health Service Request Form



Pharmacy and Outpatient Drug Services

icon Medicaid Pharmacy Prior Authorizations
icon Medicaid Prior Authorization Code Matrix for Outpatient Drug Services
icon Texas Standardized Prior Authorization Form for Prescription Drugs


 Provider News Bulletins
 icon Provider News Bulletin Prior Authorization Code Matrix - May 2022 
icon Provider News Bulletin Prior Authorization Code Matrix - March 2022 

Archived Provider News Bulletins
icon Provider News Bulletin Prior Authorization Code Matrix - November 2021
icon Provider News Bulletin Prior Authorization Code Matrix - September 2021
icon Provider News Bulletin Prior Authorization Code Matrix - May 2021
icon Provider News Bulletin - Essential Information - April 2021 
icon Provider News Bulletin Prior Authorization Code Matrix- February 2021
icon Provider News Bulletin Prior Authorization Code Matrix - January 2021