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Behavioral Health Service Request Form - Molina

Behavioral Health Service Request Form - Molina 2025

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The document is a Follow-Up Appointment Request Form for Behavioral Health Case Management, intended for use by the South Carolina Department of Mental Health and Community Mental Health staff. It collects essential member information, appointment details, and confirmation of attendance. The form also includes contact information for Healthy Blue and fraud reporting instructions.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (91 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is auth required for Molina?

Only your provider can request a prior authorization to Molina Healthcare. You cannot request one. This is done to make sure that you get the right care. You need a prior authorization to make sure that the care and services you receive are medically necessary.

Is prior authorization always required?

Is prior authorization required in emergency situations? No, prior authorization is not required if you have an emergency and need medication. However, coverage for emergency medical costs are subject to the terms of your health plan.

Who requires a prior authorization?

Prior authorizations are usually only required for more costly, involved treatments where an alternative is available. For instance, if a physician prescribes an invasive procedure such as orthopedic surgery, it will likely require preauthorization.

Does Molina cover mental health services?

Health Services (Inpatient and Outpatient): Molina covers Mental Health Services when provided by Participating Providers and facilities acting within the scope of their license. Molina covers the diagnosis or treatment of mental disorders, including services for the treatment of gender dysphoria.

Does Molina require a referral to see a specialist?

If you need special care that your PCP cannot give, he or she will refer you to a specialist. Getting a referral from your PCP is not required, but it ensures all your providers know your health care goals and plans.

What is the controversy with Molina Healthcare?

0:26 4:27 Some durable medical equipment like hospital beds or electric wheelchairs. For the best outcomes theMoreSome durable medical equipment like hospital beds or electric wheelchairs. For the best outcomes the prior authorization. Process should start with your provider.

Behavioral Health Service Request Form - Molina 2025

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