Payment Integrity Policies
Molina Healthcare of TX 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- Hydrolyzed Enteral Formula Diagnosis
- Inpatient services billed on Outpatient bill types
- Medically Unlikely Edits
- NPFS Status Indicator T
- Modifier 25
- Modifier 26
- Modifier KX
- Non-Invasive Abdominal/Visceral Vascular Studies
- Overlapping Room and Board
- Physical Therapy Max Units Per Day
- Psychotherapy Add On with High Level EM
- Therapy Modifier Coding
- Unspecified Codes in an Inpatient Setting
- Appropriate Level of Care Reimbursement
- 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
- Excludes 1 Note
- Facility Emergency Department Evaluation and Management leveling
- High Dollar Pharmacy
- High Level Evaluation and Management with Preventive Medicine
- Hospital Routine Supplies Services
- ICD-10 Specificity Coding Policy
- ICD-10 First Listed Diagnosis Coding Policy
- Optum Pause and Pay
- Readmission
- Sepsis
- Split-Night-Sleep-Study
- Newborn and NICU
- Corrected Claims
- Duplicate Claims
- General Coding
- Molina Healthcare Audit/Recovery: Variable Discount Payments for Providers
- Molina Healthcare Cross-Departmental Audit and Recovery
- Multiple Procedure Payment Reduction
- NPFS Status Indicator T
- Post-Pay Authorization Audit
- Post Pay General
- Semiprivate Vs Private Room
- Ambulance Modifier
New-Pending Policies
Existing Policies