Updates and Bulletins
Provider Quick Reference Guide
Children's HCBS Authorization and Care Manager Notification Form
Optum-Change Healthcare Outage update (March 18, 2024)
Effective April 1 2024 Essential Plan 200 250 Provider Notification
2/29/24: Optum-Change Healthcare Outage Update
2/26/24: Optum-Change Healthcare Outage
FAQ- Optum Pause & Pay Program
Effective March 1, 2024: Services in link are allowed in all Network Physician’s Office Setting
February 2024 Quality Commercial
January 2024 Quality Commercial
Submit and Track Your Appeals on Availity Essentials
Provision and Coordination of Services for Children/Youth in Foster Care
Important Information from the Quality Department: Quality Commercials:
2/1/24: Molina General Provider Notice of Healthmap
2/1/24: EDSD Guidance for Providers
2/1/24: Provider Newsletter Q4 2023
1/1/24: Child Health PLUS Expanded Benefits to include Home and Community Based Services (HCBS)
11/28/23: Enhancement to Reporting of Refunds on EOPs
9/11/23: Provider Newsletter Q3 2023
9/1/23: Effective 9/1/23 - Claims submitted with missing, invalid, and incomplete NDC Information will be denied
8/21/23: Medicaid PDMP Reminder
8/18/23: Reminder: There is a Prior Auth LookUp Tool for J Codes or other HCPCS codes for medications
7/26/23: Reminder: Molina has a LookUp Tool for J Codes and other HCPCS codes for medications on our website
7/1/23: Effective 7/1/23: Changes to Prior Authorization Requirements
6/1/23: Provider Newsletter - Q2 2023
5/1/23: Effective 5/1/23: Fax Size Limitation for Clinical Information
4/1/23: Effective 4/1/23: Addition of Residential Rehabilitation Services for Youth (RRSY) Benefit for CHP (Grid)
3/1/23: Provider Newsletter - Q1 2023
3/1/23: Effective 3/1/23: Changes to Prior Authorization Requirements
1/1/23: Effective 1/1/23 – Grid of Benefit Changes for all Lines of Business
1/1/23: Provider Net Sunsetting Notice
1/1/23: Effective 1/1/23 – Molina will no longer accept claims submitted via non-approved submission pathways
12/2/22: Q4 2022 Provider Newsletter
12/22: Implementation of new payment platform through ECHO Health complete
10/1/22: Effective 11/1/22: Change to PA Requirements for PT/OT/ST
10/1/22: Effective 11/1/22: Change to PA Requirements for Home Care
6/1/22: Pharmacy Real-Time Prescription Benefits Tool Now Available
- RTB Information at Point of Care Document
- Real-Time Prescription Benefits Access and Onboarding Handbook
5/25/22: New MCG AutoAuth Process– Advanced Imaging
- Availity Portal Instructions
2/1/22: Adult BH HCBS transition to CORE
1/24/22: Additional Provider Education - Services Provided to Children/Youth in Foster Care
1/1/22: Beacon Health Benefits End for Downstate Affinity by Molina Healthcare Members
- Provider FAQs - Beacon Transition
- General Provider Notice - Beacon Transition
11/1/21: Molina Healthcare of New York, Inc. will partner with Progeny Health, LLC
10/1/21: Applied Behavioral Analysis Benefit (ABA) - Changes in Prior Auth Codes
9/1/21: Prior Auths will transition back to Molina (away from eviCore)
4/1/21: Molina Partners with Locus Calocus
4/12/21: Removal of Knee Replacement Procedure Code
3/1/21: Molina Partners with MCG Health
Provider Newsletters (prior editions)
Q2 2022 NCQA Provider Newsletter
Q2 2021 NCQA Provider Newsletter
2020 Q4 MHNY Provider Newsletter
2020 Q3 MHNY Provider Newsletter
2020 (Q2) NCQA Provider Newsletter
2020 Q1 Provider Newsletter
2019 Q4 Provider Newsletter
2019 NCQA Provider Newsletter (Q2)
2019 Q1 Provider Newsletter
Provider Communications Archive
Crisis Residence Services - Effective 12/1/20
COVID Payment Policy (when rates are unavailable)
Mock HEDIS Audit - 10/5-12/11
New Drug and Biological Pre-Payment Code Edits - Effective 11/24/20
Reduction in PA Codes - Home Health Services - Effective 10/1/20 * CDC Guidelines
Molina itemized billing effective 7/15
New Prepayment Claims Review beginning 6/30/20
Patient Cost-Sharing for Laboratory Tests to Diagnose COVID-19
Coronavirus: Utilization Review and Emergency Admission Notification
New Prepayment Claims Review
COVID-19 Telehealth Billing
Coronavirus Provider FAQ
eviCore New Prior Authorization Requirements Effective 4/1/20
Corona Virus Talking Points for Providers
Pre Pay Audit Provider Notification Letter
Pharmacy Network Changes Effective 1/1/20
eviCore Update
eviCore HOLD Notification
New Prior Authorization Requirements through eviCore Mobile Health Spot
Member Incentive Program
New Prior Authorization Requirements through eviCore
Changes to Prior Authorization Requirements effective 10/01/2019
Prior Authorization Update_SPA Services
Provider Update: Review of Sepsis and Septic Shock
Provider Bulletin Archive
Provider Bulletin- NICU Payment Review Policy
Provider Bulletin- MHNY Provider Letter Fertility Benefits
Provider Bulletin- MHNY Provider letter Children's Carve In
Provider Bulletin- June 2019: New Appeal Request Form