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MOLINA COMPLETE CARE Service Authorization (SA) Form HEPATITIS C ANTIVIRALS, PREFERRED If the following information is not complete, correct, or legible, the SA process can be delayed. Please use
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Gather all necessary personal information such as name, date of birth, address, and contact information.
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Contact Molina Complete Care service either through their website, phone, or in person.
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Fill out the required forms accurately and completely, making sure to include any relevant medical history or insurance information.
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Submit the completed forms either online, by mail, or in person to the designated Molina Complete Care office.
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Await confirmation of enrollment and coverage details from Molina Complete Care.

Who needs molina complete care service?

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Individuals who are eligible for Medicaid or Medicare
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Individuals with chronic health conditions requiring ongoing care
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Individuals looking for comprehensive managed care services
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Molina Complete Care service is a managed care organization that provides healthcare services to individuals who are eligible for Medicaid.
Individuals who are enrolled in Molina Complete Care service are required to file.
To fill out Molina Complete Care service, you must provide accurate information about your healthcare needs and coverage.
The purpose of Molina Complete Care service is to ensure that individuals receive the necessary healthcare services covered by their Medicaid benefits.
Information such as medical history, prescription medications, and healthcare provider visits must be reported on Molina Complete Care service.
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