Payment Integrity Policies
Molina Healthcare of MS Medicaid Payment Integrity Payment Policies
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Molina Healthcare Medicare and Marketplace Payment Integrity Payment Policies- Anesthsia Bundling
- Aortography and Peripheral Angiography
- Colonoscopies and Sigmoidoscopy
- Co Surgeon Team Surgeon Professional
- Discontinued Procedures
- Global Surgical Packages for Professional Providers
- Hydrolyzed Enteral Formula Diagnosis
- Inpatient services billed on Outpatient bill types
- Injection and Infusions in the ER with 25 Modifier
- Medically Unlikely Edits
- Modifiers XE XS XP XU and 59 Usage
- Multiple EM codes for the same provider same date of service
- NPFS Status Indicator T
- Modifier 26
- Modifier KX
- Molecular Pathology
- 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
- Pulmonary Function Testing
- Physical Therapy Max Units Per Day
- PT/OT Initial Evaluations
- PT/OT/ST Yearly Limit
- Reduced Services and Discontinued Procedures
- Status Indicator Flag B Bundled Codes
- Tendon Injections Missing Diagnosis
- Therapy Modifier Coding
- Unspecified Codes in an Inpatient Setting
- Appropriate Level of Care Reimbursement
- BRCA1 and BRCA2 Genetic Testing
- Breast Cancer Genetic Testing Tier 1 vs Tier 2
- Critical Care Codes when Discharging Home from the Emergency Department
- Diagnosis Code Coding
- DRG Clinical Validation
- Excludes 1 Note
- Facility Emergency Department Evaluation and Management leveling
- High Level Evaluation and Management with Preventive Medicine
- High Dollar Pharmacy
- Hospital Routine Supplies Services
- Hospice
- ICD-10 Specificity Coding Policy
- ICD-10 First Listed Diagnosis Coding Policy
- Newborn and NICU
- Readmission
- Sepsis
- Semiprivate Vs Private Room
- Split-Night-Sleep-Study
- Overlapping Room and Board
- Optum Pause and Pay
- Observation
- Advance Beneficiary Notice (ABN) Modifiers GA, GX, GY and GZ
- After Hours and Weekend Care Professional
- Annual Wellness Visit sooner than 11 months following Initial IPPE
- Corrected Claims
- CMS Replacement Codes
- Duplicate Claims
- Fee Schedule
- General Coding
- Interim Hospital Claims
- Post Pay General
- Paid Amount Exceeded Billed Amount
- Post-Pay Authorization Audit
- Medical Supplies Home Health Consolidated Billing
- Molina Healthcare Billing Requirements
- Molina Healthcare Cross-Departmental Audit and Recovery
- Molina Healthcare Audit/Recovery: Variable Discount Payments for Providers
- Molina Healthcare: Audit/Recovery for Revenue to CPT Code Review
- Molina Healthcare Audit Recovery for Billed Units
- Molina Healthcare Audit.Recovery for CPT to CPT Code
- Molina Healthcare Audit.Recovery for Diagnosis Codes
New-Pending Policies
Existing Policies