Pharmacy providers must enroll with Medicaid before participating in managed care pharmacy networks.
Refer to the MCO Complaint Process
Some Medicaid drugs are subject to one or both types of prior authorization, clinical and non-preferred. There are certain clinical prior authorizations all Medicaid MCOs are required to perform. Usage of all other clinical prior authorizations will vary between MCOs at the discretion of each MCO.
Prescribing providers or their representatives should contact the MCO's prior authorization call center. The MCO must notify the prescribing provider of authorization approval or denial within 24 hours of the time of the request.