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Web complete the molina healthcare service request form or the ohio care coordination plan standardized prior authorization request form. Commercial (marketplace) medicaid mmp medicare. Prior authorization is when your provider gets approval from. Web ohio department of medicaid | 50 west town street, suite 400, columbus, ohio 43215.
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• submit requests directly to molina via the provider portal. Elective, acute hospital, skilled nursing facilities (snf), rehabilitation and long term acute care. Web molina healthcare prior authorization request form *the expedited/urgent service request designation should only be used if the treatment is required to prevent serious. Web provider information medication requested patient previous medication(s) relevent to this request* relevant medical rationale for request/additional clinical information.