Payment Integrity Policies
Molina Healthcare Medicaid Payment Integrity Payment Policies
For Molina Healthcare Active Medicare and Marketplace, Please click the link.
Molina Healthcare Medicare and Marketplace Payment Integrity Payment Policies- Add-on Coding
- Colonoscopies and Sigmoidoscopy
- Co Surgeon Team Surgeon Professional
- Critical Care Codes when Discharging Home from the Emergency Department
- Decision for Surgery Modifier 57
- Diagnosis Code Coding
- Discontinued Procedures
- Global Surgical Packages for Professional Providers
- Hydrolyzed Enteral Formula Diagnosis
- ICD-10 First Listed Diagnosis Coding Policy
- ICD-10 Specificity Coding Policy
- Injection and Infusions in the ER with 25 Modifier
- Inpatient services billed on Outpatient bill types
- Medically Unlikely Edits
- Modifier 25
- Modifier 26
- Modifier KX
- Modifier TC
- Multiple EM codes for the same provider same date of service
- Multiple Procedure Payment Reduction
- NCCI PTP with Modifiers
- Non-Invasive Abdominal/Visceral Vascular Studies
- Physical Therapy Max Units Per Day
- Podiatric Q Modifiers
- PT/OT Initial Evaluations
- Reduced Services and Discontinued Procedures
- Tendon Injections Missing Diagnosis
- Therapy Modifier Coding
- Unspecified Codes in an Inpatient Setting
- Appropriate Level of Care Reimbursement
- BRCA1 and BRCA2 Genetic Testing
- Breast Cancer Genetic Testing Tier 1 vs Tier 2
- DRG Clinical Validation
- Excludes 1 Note
- Facility Emergency Department Evaluation and Management leveling
- Hospice >
- Hospital Routine Supplies Services
- Optum Pause and Pay
- Newborn and NICU
- Non-Invasive Prenatal Testing
- Observation
- Overlapping Room and Board
- High Level Evaluation and Management with Preventive Medicine
- Polysomnography Studies and Home Sleep Testing
- Psychotherapy Add On with High Level EM
- Readmission
- Sepsis
- Split-Night-Sleep-Study
- Advance Beneficiary Notice (ABN) Modifiers GA, GX, GY and GZ
- After Hours and Weekend Care Professional
- Corrected Claims
- Duplicate Claims
- Fee Schedule
- Medical Supplies Home Health Consolidated Billing
- Molina Healthcare Audit.Recovery for CPT to CPT Code
- Molina Healthcare Billing Requirements
- Molina Healthcare General Coding Policy
- Paid Amount Exceeded Billed Amount
- Post Pay General
- Post-Pay Authorization Audit