Payment Integrity Policies
Molina Healthcare of AZ 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-
Add-on Coding - Anesthesia Bundling
- CMS Replacement Codes
- Co Surgeon Team Surgeon Professional
- Critical Care Codes when Discharging Home from the Emergency Department
- Decision for Surgery Modifier 57
- Diagnosis Code Coding
- Diagnosis Code Y65 XX
- Discontinued Procedures
- Emergency EM Codesand Place of Service
- Global Surgical Packages for Professional Providers
- Hospice Value Code 61
- Hydrolyzed Enteral Formula Diagnosis
- ICD-10 First Listed Diagnosis Coding Policy
- ICD-10 Specificity
- Incarceration Diagnosis Code
- Inpatient services billed on Outpatient bill types
- Medically Unlikely Edits
- Member PCP as Attending Provider in a ER Facility Setting
- Modifier TC
- Modifier 25
- Modifier 26
- Modifier KX
- Modifiers XE XS XP XU and 59 Usage
- MP Facility Bilateralor Anatomical Modifier Use
- Multiple EM codes for the same provider same date of service
- NCCI PTP with Modifiers
- NPFS Status Indicator T
- Outpatient Hospital Blood and Blood Products Policy Facility
- Physical Therapy Max Units Per Day
- Podiatric Q Modifiers
- Procedure to Place of Service Policy Professional
- PT OT Initial Evaluations
- PT OT Initial Evaluations
- Reduced Services and Discontinued Procedures
- Repeat Procedure Modifiers 76 77
- Status Indicator Flag B Bundled Codes
- Tendon Injections Missing Diagnosis
- Therapy Modifier Coding
- Treatment Room Revenue Codes Billed with E&M Services
- Unlisted Coding
- Unspecified Codes in an Inpatient Setting
- 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
- General Anesthesia and IV Sedation for Pediatric Dental Services
- 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
- Allergy Testing
- Clinical Diagnostic Laboratory Services
- Lab Codes with Modifiers 59 and 91
- Lab Panel
- Labs Overlapping with Facility
- Molecular Pathology
- Non-Invasive Prenatal Testing
- Packaged and conditionally packaged lab services
- Physician Office Laboratory Testing
- Respiratory Pathogen Panel Testing
- Specimen Validity Testing
- STI Lab Panel Testing
- After Hours and Weekend Care Professional
- Authorization Review
- Children and Cancer Hospitals Marketplace
- Cross-Departmental Recovery Policy
- Duplicate Claims
- Fee Schedule
- General Billing and Coding Policy
- Interim Hospital Claims
- Marketplace FQHC and RHC
- Medical Supplies Home Health Consolidated Billingl
- MemberNotActive12162024l
- Multiple Procedure Payment Reduction
- Paid Amount Exceeded Billed Amount
- Recovery Policy for Billed Units Service Accumulator
- Recovery Policy for CPT to CPT Code
- Recovery Policy for Diagnosis Codes
- Recovery Policy for Revenue to CPT Code Review
- Recovery Policy Variable Discount Payments for Providers
- Semiprivate Vs Private Room
- Urgent Care Marketplace
- Advanced Beneficiary Notice ABN Modifiers GA GX GY GZ
- Overlapping Room and Borad
- Corrected Claims
- Annual Wellness Visit sooner than 11 months following Initial IPPE
- Targeted Case Management Policy
- Ambulatory Echocardiograph Monitoring
- Aortography and Peripheral Angiography
- Autonomic FunctionTesting
- CT Computed Tomography of the Abdomen and Pelvis
- Electrocardiographic EKG or ECG Monitoring Holteror Real Time Monitoring
- Image Guided Radiation Therapy
- Non Invasive Abdominal Visceral Vascular Studies
- Pulmonary Function Testing
- Radiology Bone Density
- Radiology for chest
- Colonoscopy and Sigmoidoscopy
- PolysomnographyStudies and Home Sleep Testing
- Radiology Frequency for Simple Syncope Policy