Over the last several months, My Choice Wisconsin by Molina Healthcare (MCW) has completed a thorough review of prior authorization requirements for the Family Care Partnership and Medicare Dual Advantage (DSNP) lines of business. Our ultimate goal is to decrease the administrative burden on your staff while ensuring our members get the right care at the right place at the right time.

We are pleased to share that as a result of this comprehensive review, a large volume of codes (over 5,000!) will be removed from the MCW prior authorization list. These services will no longer require a prior authorization beginning January 1, 2025.

 In addition, we are enhancing the functionality to help you and your staff easily find when  prior authorization is required. Effective January 1, 2025, you will notice a new link on the My Choice webpage for the Prior Authorization LookUp tool. This tool will allow you to enter a specific CPT code to determine if prior authorization is needed. This functionality is consistent with what Molina currently offers for the Medicaid BadgerCare+, SSI and Marketplace lines of business.

These changes do not impact authorization requirements for long-term care services. Long- term care services will still require authorizations regardless of what is listed in the Prior Authorization LookUp tool and are driven through care planning.

To ensure our members receive appropriate access to care, Molina will honor all existing authorizations that span January 1, 2025. You will not need to resubmit.

 For more information on prior authorization requirements for 2025, review the prior authorization guidelines online at mychoicewi.org/providers/authorizations.

Questions?

We’re here to help. Contact the My Choice Wisconsin Contact Center with questions, concerns, or for more information (800) 963-0035.