Molina Healthcare Requires Prior Authorizations for OT/PT/ST
We need to get this message out to as many providers as possible before July 1st, 2017. Molina Healthcare will begin requiring prior authorizations for all OT/PT/ST services beyond 7/1/2017. I’m not exactly sure why this wasn’t required all along but here we go. I first received word by fax a couple weeks ago and after multiple calls and emails to Molina for clarification, I finally spoke with someone who was aware of the change and could provide more information. See the message below from the Molina provider relations department.
“You will be required to submit authorizations for PT/OT/ST for all Lines of Business effective 7/1/2017 for all Par and non-par providers. You should begin to submit authorizations for all members who will receive therapy as of 7/1/2017. If you receive an auth back stating “no auth needed” please reach out to the Utilization Management team and advise the Dates of Service are after 7/1/2017. You will need an auth, and I want to make sure you are aware of that, so we don’t run into claims issues.”
This is a big change from the standard procedure and a lot of practices will have to make major changes to their processes to accommodate this change. I have one client who has more than 100 Molina patients. Lucky for her, I do all her Authorizations so she won’t have to worry about the change. Is your practice ready for the change? Did you know there are two ways to submit prior authorizations to Molina?
Use their website. https://provider.molinahealthcare.com/Provider/Home If you’re a participating provider with Molina, you should have an account with Molina’s provider portal. There is a process for submitting prior authorizations through their website and that will be the best way to submit and check the status of your PA submission.
Fill out the PA Request Form and Fax it in. Molina has a one-page prior authorization request form that is pretty straightforward to fill out. You can fax that request for along with a copy of the signed Plan of Care and Evaluation to 866-440-9791.
You have a little more than 3 weeks at the time of this writing to figure out how to adjust your internal processes to accommodate this change and get all your current patients submitted for authorizations starting on July 1st, 2017.
As always, I’m here to help with your questions and concerns. Contact me at info@extramilebilling.com if you need a copy of the Molina Pre-Auth Submission Form and an example of how to fill it out.