Payment Integrity Policies
Molina Healthcare of MI 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
- Anesthsia Bundling
- Colonoscopies and Sigmoidoscopy
- Co Surgeon Team Surgeon Professional
- Global Surgical Packages for Professional Providers
- Hydrolyzed Enteral Formula Diagnosis
- Injection and Infusions in the ER with 25 Modifier
- Medically Unlikely Edits
- NPFS Status Indicator T
- Modifier 25
- Modifier 26
- Modifier KX
- Modifier TC
- Multiple Procedure Payment Reduction
- Non-Invasive Abdominal/Visceral Vascular Studies
- Podiatric Q Modifiers
- Polysomnography Studies and Home Sleep Testing
- Psychotherapy Add On with High Level EM
- PT/OT Initial Evaluations
- PT/OT/ST Yearly Limit
- Repeat Procedure Modifiers 76 77
- Status Indicator Flag B Bundled Codes
- Therapy Modifier Coding
- Unlisted Coding
- Unspecified Codes in an Inpatient Setting
- Appropriate Level of Care Reimbursement
- BRCA1 and BRCA2 Genetic Testing
- Critical Care Codes when Discharging Home from the Emergency Department
- Diagnosis Code Coding
- DRG Clinical Validation
- Excludes 1 Note
- Emergency E&M Codes and Place of Service 23
- Facility Emergency Department Evaluation and Management leveling
- High Level Evaluation and Management with Preventive Medicine
- High Dollar Pharmacy
- Hospital Routine Supplies Services
- Hospice
- Hospice Value Code 61
- ICD-10 First Listed Diagnosis Coding Policy
- ICD-10 Specificity Coding Policy
- Newborn and NICU
- Readmission
- Sepsis
- Semiprivate Vs Private Room
- Split-Night-Sleep-Study
- Overlapping Room and Board
- Optum Pause and Pay
- Observation
- After Hours and Weekend Care Professional
- Corrected Claims
- Duplicate Claims
- General Coding
- Interim Hospital Claims
- Post Pay General
- Paid Amount Exceeded Billed Amount
- Post-Pay Authorization Audit
- Molina Healthcare Billing Requirements
- Molina Healthcare: Audit/Recovery for Revenue to CPT Code Review
- Molina Healthcare Audit Recovery for Billed Units
- Molina Healthcare Audit.Recovery for Diagnosis Codes