Forms
Here you can find all your provider forms in one place. If you have questions or suggestions, please contact us.
Provider Services phone: (833) 685-2103
- Appeals and Reconsiderations
- Authorizations/Utilization Management
Prior Authorization Requests
- Notice of Decision, Behaviorally Complex Care Program Form
- Behavioral Health Prior Authorization Request Form and Instructions
- Prior Authorization Request Form and Instructions
- 278 – Service Request for Review and Response
Prior Authorization Reconsiderations and Appeals
- Claims
- Credentialing/Contracting
- Pharmacy
- Other Forms
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CMS-0057 Prior Authorization Annual
Reporting
Nevada Medicaid Prior Authorization Annual Report 2025
Prior Authorization Statistics Molina Healthcare IncPercentageThe percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. 82% The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. 18% The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. 70% The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. 69% The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 59% The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. 67% The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. 87% The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. 13% Timing Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 7 Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) 6 Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 33 Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) 28
