Molinalogo

MI Interpreter Request Form

Health Education Referral Form

Home Health Patient Drive Groupings Model (PDGM) FAQs

Claims Dispute Request Form

Home Care FAQ

Provider Addition Roster

Molina Healthcare of Michigan Provider Contract Request Form

Authorized Representative Designation

Provider Change Form

Prior Authorizations 

Q1 2023 PA Matrix including NCH Cardiology Management Program - Effective 3-1-2023

2022 Prior Authorization Matrix - Effective 10/01/2022

2022 Prior Authorization Guide - Effective 10/01/2022

Prior Authorization/Pre-Service Review Guide - Effective 10/01/22

2022 Prior Authorization Matrix - Effective 07/01/2022

2022 Prior Authorization Guide - Effective 07/01/2022

2022 Prior Authorization Guide - Medicare - Effective 07/01/2022

2022 Prior Authorization Guide - Effective 04/01/2022

Prior Authorization/Pre-service Review Guide - Effective 04/01/22

2022 Prior Authorization Matrix - Effective 04/01/2022

2022 Prior Authorization Guide - Effective 01/01/2022

2022 Prior Authorization Guide - Medicare - Effective 01/01/2022

2022 Prior Authorization Matrix - Effective 01/01/2022

Prior Authorization Forms

Prior Authorization Form

Pharmacy Prior Authorization Form

Behavioral Health Prior Authorization Form

MI-Alternative Level of Care Authorization Form

MI-OB Notification Form

Physician Office Laboratory Tests

Provider Change Form

Provider Change Form Requirements and Guidelines

Provider Request to Change PCP Form

Community Connector Reference Guide

Community Connector Referral Form

CAHPS Provider Brochure