Molina Healthcare Prior Authorization Documentation Requirements

This document is a provider memo from Molina Healthcare of Illinois, outlining new requirements for documentation related to Prior Authorization (PA) requests. Effective October 20, 2025, providers must attach additional clinical documentation, including clinical records, for all PA submissions via the Availity platform. The memo emphasizes that clinical documentation is now a mandatory field for submitting requests. It details the process for inpatient admissions and outpatient services, reminding providers of the two business days allowed for submission after admission. The memo explains that this update aims to streamline the PA review process, reduce communication delays with the Utilization Management team, and improve decision-making efficiency, ultimately leading to better patient outcomes. Providers are instructed to ensure that clinical records submitted pertain only to the specific PA being requested, with a maximum file size limit specified. Contact information for support is also provided.