Welcome, Molina Dual Options Healthy Connections Prime Providers!

Need a Prior Authorization?

* When Prior Authorization is 'Required', click here to create Service Request/Authorization

Become a Molina Dual Options Provider

Contracted providers are an essential part of delivery quality care to our members. We value our partnership and appreciate the family-like relationship that you pass on to our members.

As our partner, assisting you is one of our highest priorities. We welcome your feedback and look forward to supporting all your efforts to provide quality care.

If you have any questions or if you are interested in becoming a Molina Dual Options provider, please call Provider Services at (855) 237-6178.

Medicare Compliance Program

Medicare Compliance Training

Prior Authorization (PA) Updates

icon  Prior Authorization Guide

icon  Prior Authorization Request Form

icon  BH Prior Authorization Request Form

icon  Pharmacy PA Request Form

Quick Links

Provider Portal

Provider Manual

Frequently Used Forms

Newsletters

Opioid Treatment Program Information

Please click here for more information on the Opioid Treatment Program.

Authorization Fax Number Changes

Molina Dual Options Medicare-Medicaid Plan and Molina Medicare Complete Care HMO SNP implemented a change in fax numbers for submission of prior authorization requests. The fax numbers are listed below.

Molina Dual Options:

  • Outpatient & Elective Inpatient: (844) 251-1451
  • Inpatient Admission Notification & Concurrent Review: (844) 834-2152

Molina Medicare Complete Care:

  • Outpatient & Elective Inpatient: (844) 251-1450
  • Inpatient Admission Notification & Concurrent Review: (844) 834-2152

This is only a change in the fax numbers utilized to submit for prior authorization and/or notification of admission and clinical for UM review.  

ACR Information

Molina has incorporated American College of Radiology (ACR) guidelines into Molina's criteria of clinical decision support for advanced imaging. For more information contact Provider Services at (855) 237-6178 or email at click here

Important Reminder

Please notify Molina Healthcare at least 30 days in advance when you have any of the following:

  • Change in office location, office 
       hours, phone, fax, or email
  • Addition or closure of office location
  • ​Addition or termination of a provider
  • Change in Tax ID and/or NPI
  • Open or close your practice to new
       patients (PCPs only)
​