Pay per submission with credits or a one-time card payment. Cost depends on patient or provider use and delivery method. No monthly subscription is required.
Medical office pricing per submission
Fax: 5 credits, or $4.99 by card when credits are insufficient.
Portal, phone or mail: 3 credits, or $2.99 by card when credits are insufficient.
Office approval is separate from payment. Personal and shared office credit balances are separate.
Prior authorization to Molina Healthcare
Molina Healthcare operates state Medicaid and Marketplace plans across multiple states, but there is no single national PA fax number. Each state subsidiary maintains its own submission fax number, required forms, and clinical review criteria. Call Molina Provider Services for your specific state before submitting to get the correct fax number — a PA faxed to the wrong state office will not be processed and may not be acknowledged.
Molina Healthcare
- PA Fax
- Enter manually
- PA Phone
- +18887569417
- Standard turnaround
- 5 business days
- Urgent turnaround
- 72 hours
Fax number varies by state plan. Call Molina Provider Services for your state-specific fax number.
Molina Healthcare provider portal →What you'll need
- ☐Identify your state Molina plan — fax number and requirements differ by state
- ☐Call Provider Services to get state-specific fax number before submitting
- ☐Patient member ID
- ☐ICD-10 diagnosis code(s)
- ☐CPT procedure code(s)
- ☐Clinical notes and prior treatment history
- ☐Ordering provider NPI
▶▼Common denial reasons
- ⚠State-specific Medicaid criteria not met
- ⚠Prior treatment history not documented (step therapy required)
- ⚠Service not on state Medicaid fee schedule
- ⚠Missing state-specific required documentation
Verified 2026-05-20. Check payer site for current rules →
From $2.99 per submission
Sign up free — pay by card or credits.
⚠️ BAA required for PHI
Self-service FaxSeal is not authorized for PHI. Do not use this provider workflow for HIPAA-regulated PHI unless your organization has a countersigned Enterprise BAA and written implementation approval.
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