Molina Healthcare
Welcome to the Molina Healthcare page (including ConnectiCare and Passport by Molina Healthcare). The documents on this page have been designed to help RadMD users navigate the prior authorization process for each program Evolent is responsible for managing.
Beginning September 1, 2026, prior authorization through Evolent will be required for the following non-emergent advanced imaging services, when ordered by any provider specialty, for applicable Molina Healthcare markets and members (Molina Illinois, Michigan, Wisconsin, Connecticut (ConnectiCare) and Kentucky (Passport by Molina Healthcare): CT / CTA, MRI / MRA and PET scans.
Beginning August 1, 2026, prior authorization through Evolent will be required for the following non-emergent advanced imaging services, when ordered by any provider specialty, for applicable Molina Healthcare markets and members (Molina Iowa, Nevada and Utah): CT / CTA, MRI / MRA and PET scans.
If you have any questions about our programs, please contact [email protected]
Advanced Imaging Program
Refer to the Evolent Utilization Review Matrix resource document to view specific codes managed by Evolent. Providers should verify PA requirements using Molina Healthcare’s PA Lookup Tool.
- Applicable markets effective September 1: CT, IL, KY, MI and WI (includes ConnectiCare and Passport by Molina Healthcare)
- Applicable markets effective August 1: IA, NV and UT
Evolent Program Resource Documents
- Evolent Utilization Review Matrix
- Evolent Scope of Service: Marketplace - CT, IL, KY, NV, UT
- Evolent Scope of Service: Medicaid - IA, IL, KY, MI, NV, UT, WI
- Evolent Scope of Service: Medicare - CT, IA, IL, KY, MI, NV, UT
Frequently Asked Questions (FAQs)
- Frequently Asked Questions: CT (ConnectiCare)
- Frequently Asked Questions: IA
- Frequently Asked Questions: IL
- Frequently Asked Questions: KY (Passport by Molina Healthcare)
- Frequently Asked Questions: MI
- Frequently Asked Questions: NV
- Frequently Asked Questions: UT
- Frequently Asked Questions: WI
For access to our Advanced Imaging conservative treatment forms, tip sheets/checklists, click here.
Clinical Guidelines
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.