Welcome, Florida Healthcare Providers
Contracted providers are an essential part of delivering quality care to our members. We value our partnership and appreciate the family-like relationship that you pass on to our members.
As our partner, assisting you is one of our highest priorities. We welcome your feedback and look forward to supporting all your efforts to provide quality care.
If you have any questions, please call Provider Services at 855-322-4076.
Institutional Billing Requirements
Effective August 1, 2017, Molina Healthcare will configure our claims reimbursement systems to require all institutional claims to comply with the guidelines described in the Provider Reimbursement Handbook, UB-04.
The updates will include specific requirements for Institutional Encounter Data, including but not limited to:
- Value Codes for Inpatient Institutional Claims
- Bill Types for Hospice
- Interim Institutional Claims
- Type of Bill Codes
To review the updates and ensure adherence to the system requirements and avoid any Claims Denials, please click here.
Thank you for your compliance, and if you have any questions about this or any other communication, please contact MFL Provider Services at 855-322-4076 or email us at: MFLProviderService@MolinaHealthcare.com.
Service Location Requirement for Professional Claims
In order to ensure appropriate reimbursement of professional claims for providers whose contracted fees are based on Medicare rates, Molina Healthcare of Florida will now require service locations on the CMS-1500 form, box 32, and its electronic equivalent.
Medicare rates are determined, in part, by the specific locality in which a service is rendered. Therefore, the service location must be included on the claim to ensure that the correct locality rate is selected during claims adjudication, and reduce miscalculated payments.
If your rates are based on a percentage of Medicare's fee schedule for any contracted line of business, including Medicaid and Marketplace, you must include service locations on your claims as of March 1, 2017. Failure to include service locations on your professional claims may result in claims denials.
If you have any questions regarding this communication, please contact Provider Services at 855-322-4076.