Payment Integrity Policies



Payment Integrity Policy Disclaimer

The intended audience of these Payment Integrity Policies is healthcare providers who treat Molina members. These policies are not intended to address every aspect of a reimbursement situation, nor is it intended to impact care decisions. These policies were developed using nationally accepted industry standards and coding principles. In the event of a conflict, federal and state guidelines, as well as the member’s benefit plan document always supersede the information in a payment policy. Additionally, to the extent there are any conflicts between the payment policy and the provider contract language, the provider contract language will prevail. Coverage may be mandated by applicable legal requirements of a State, the Federal government or the Centers for Medicare and Medicaid Services (CMS). References included were accurate at the time of policy approval. These policies are subject to change or termination by Molina. Not all payment policies are posted.