Molina Healthcare of IA Payment Integrity Payment Policies
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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