Molina Healthcare Billing and Reimbursement Policies

For Benefit Interpretation Policies, please click here (for Marketplace only).

Marketplace Marketplace
Medicaid Medicaid
 Appropriate Level of Care Reimbursement
 Breast Cancer Genetic Testing Tier 1 vs Tier 2
 DRG Clinical Validation
 Excludes 1 Note
 Facility Emergency Department Evaluation and Management leveling
 High Level Evaluation and Management with Preventive Medicine
 Hospice
 Hospital Routine Supplies Services
 Newborn and NICU
 Observation
 Optum EDC Analyzer - Facility ER E&M Leveling Prepayment
 Optum Pause and Pay
 Outpatient Hospital Blood and Blood Products Policy Facility
 Psychotherapy Add On with High Level EM
 Readmission
 Sepsis
 Split-Night-Sleep-Study
 

State Specific Sites

This page lists Molina Healthcare Inc Medicare and Marketplace Lines of Business. Please check your State’s Medicaid website for policies that contain State-specific language or requirements in addition to what is listed in the corporate policy. Applicable information is listed in the Appendix at the end of policies.