July 2, 2024
My Choice/Molina Prior Authorization Reminders
On July 1, 2024, My Choice Wisconsin Medicaid SSI and BadgerCare Plus (BC+)integratedinto Molina Healthcare of Wisconsin, Inc.
All previously-approved My Choice SSI/BC+ authorizations will be honored by Molina.
- SSI/BC+ authorizations spanning the July 1 integration have been integrated automatically into the Molina system.
- Please do not resubmit already-approved prior authorization requests to Molina for reapproval. All you have to do is submit your claim once the service has been completed.
- For approved inpatient procedures, Molina requires notification at the time of admission to determine medical necessity for the inpatient stay.
SSI/BC+ authorizations for dates of service July 1, 2024 and after must follow Molina prior authorization policies and must be submitted via Availity or fax.
- We do not perform retro reviews unless there is an identified extenuating circumstance.
- We do not require authorization for observations.
- Visit our website for a helpfulPrior Auth Guide(with our UM phone #’s) andAuth Code Lookup Tool.
- If you submit an authorization for a service that does not require auth, you will receive a fax back from the UM team indicating such. Please verify what services require authorizations before submitting.
- When submitting prior auth requests, the Urgent / Expedited designation should only be used if the treatment is required to prevent serious deterioration in the member’s health or could jeopardize their ability to regain maximum function.
Questions?
Please reach out to your provider relations representative or email us at:
- MHWIprovidernetworkmanagement@molinahealthcare.com(for BadgerCare Plus, Medicaid SSI, or existing Molina Medicare)
- Shfamccontracts@mychoicewi.org(for Family Care, Family Care Partnership, or existing My Choice Medicare)