Payment Integrity Policies
Molina Healthcare Medicare and Marketplace Payment Integrity Payment Policies
For Molina Healthcare Active Medicare and Marketplace, Please click the link.
Molina Healthcare Medicare and Marketplace Payment Integrity Payment Policies- Anesthsia Bundling
- Aortography and Peripheral Angiography
- Authorized Pain Management Services with a Claim Modifier Mismatch
- Colonoscopies and Sigmoidoscopy
- Co Surgeon Team Surgeon Professional
- Discontinued Procedures
- Global Surgical Packages for Professional Providers
- Hydrolyzed Enteral Formula Diagnosis
- Inpatient services billed on Outpatient bill types
- Injection and Infusions in the ER with 25 Modifier
- Medically Unlikely Edits
- Modifiers XE XS XP XU and 59 Usage
- Multiple EM codes for the same provider same date of service
- NPFS Status Indicator T
- Modifier 26
- Modifier KX
- Modifier TC
- Modifiers XE XS XP XU and 59 Usage
- Molecular Pathology
- Multiple Procedure Payment Reduction
- Non-Invasive Abdominal/Visceral Vascular Studies
- Podiatric Q Modifiers
- Polysomnography Studies and Home Sleep Testing
- Psychotherapy Add On with High Level EM
- Pulmonary Function Testing
- Physical Therapy Max Units Per Day
- PT/OT Initial Evaluations
- PT/OT/ST Yearly Limit
- Reduced Services and Discontinued Procedures
- Status Indicator Flag B Bundled Codes
- 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
- Critical Care Codes when Discharging Home from the Emergency Department
- Diagnosis Code Coding
- DRG Clinical Validation
- Emergency EM Codes and Place of Service 23
- Excludes 1 Note
- Facility Emergency Department Evaluation and Management leveling
- High Level Evaluation and Management with Preventive Medicine
- High Dollar Pharmacy
- Hospital Routine Supplies Services
- Hospice
- Hospice Value Code 61
- ICD-10 Specificity Coding Policy
- ICD-10 First Listed Diagnosis Coding Policy
- Newborn and NICU
- Readmission
- Sepsis
- Semiprivate Vs Private Room
- Split-Night-Sleep-Study
- Overlapping Room and Board
- Optum Pause and Pay
- Optum EDC Analyzer Facility ER EM Leveling Prepayment
- Observation
- Advance Beneficiary Notice (ABN) Modifiers GA, GX, GY and GZ
- After Hours and Weekend Care Professional
- Annual Wellness Visit sooner than 11 months following Initial IPPE
- Corrected Claims
- CMS Replacement Codes
- Duplicate Claims
- Fee Schedule
- General Coding
- Interim Hospital Claims
- Post Pay General
- Paid Amount Exceeded Billed Amount
- Post-Pay Authorization Audit
- Medical Supplies Home Health Consolidated Billing
- Molina Healthcare Billing Requirements
- Molina Healthcare Cross-Departmental Audit and Recovery
- Molina Healthcare Audit/Recovery: Variable Discount Payments for Providers
- Molina Healthcare: Audit/Recovery for Revenue to CPT Code Review
- Molina Healthcare Audit Recovery for Billed Units
- Molina Healthcare Audit.Recovery for CPT to CPT Code
- Molina Healthcare Audit.Recovery for Diagnosis Codes