Get Molina Centennial Prior Authorization Form

Molina Healthcare has a full-time Medical Director available to discuss medical necessity decisions with the requesting physician at (855) 322-4080. Phone: (888) 275-8750/TTY: 711 Members who speak Spanish can press 1 at the IVR (Interactive Voice Response) prompt.

Molina Healthcare's Apple Health (Medicaid) Programs offer free or low-cost medical coverage for children and adults with lower income who are eligible for Medicaid.

Complete / Review information, sign, and date. Fax signed forms to Molina Pharmacy Prior Authorization Department at 1-888-487-9251.

The requested clinical should be faxed to Medical Management, using the appropriate fax number for the service for which authorization is requested. Medicaid Prior Authorization Fax Numbers: Physical Health: 1-800-690-7030. Behavioral Health: 866-570-7517.

By fax. Complete the Texas standard prior authorization request form (PDF). Then, fax the form to 1-866-835-9589.

If you have any questions, call Provider Services at (855) 322-4082. For the latest trainings and resources on integrated care and other best practices please click here.

For additional questions regarding Utilization Management and/or Prior Authorizations, please call 888-483-0760 or email the UM team at MHUTPriorAuthorization@Molinahealthcare.com.

You may also fax in a prior authorization at 800-391-6437.