If you live with a chronic condition, SWH of NY offers a variety of free programs that can help. The goal of these programs is to help you better understand and manage your health conditions. We work ...
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Claims
Provider Dispute Resolution Request Form
Prior Authorizations
Behavioral Health Prior Au...
HIPAA Standards for Electronic Healthcare TransactionsHIPAA required the Department of Health and Human Services (HHS) to adopt national standards for electronic healthcare transactions. All covered e...
Since HIPAA’s inception, Molina Healthcare has worked diligently and collaboratively with the broader healthcare community to achieve compliance with the federal HIPAA transactions requirements. Molin...
aMolina Healthcare’s HIPAA 5010 Readiness *Molina Healthcare is ready to test the 5010 versions of the HIPAA transactions with providers and other trading partners. We look forward to working collabo...
The Federal HIPAA regulations issued by DHHS dictate that only approved code sets may be used in standard electronic transactions. The CMS site has official resources that define these standard code s...
Molina Healthcare has implemented the HIPAA NPI requirements. Beginning May 23, 2008, HIPAA standard transactions must include NPIs. No legacy identifiers (other than the billing/pay-to provider's Ta...
Organizational Structure Supporting Quality Improvement: AccountabilityThe Board of DirectorsMolina Healthcare of Michigan's Board has ultimate authority and responsibility for the quality of care an...
Molina Healthcare of Michigan may delegate Credentialing, UM, and Claim activities to provider groups that meet delegation requirements. Prior to delegation, Molina Healthcare conducts on-site delega...
The Molina Healthcare QI Program encompasses the quality of acute, chronic and preventive health care and service provided in both the inpatient and outpatient setting to our population as determined ...
