Updates and Bulletins

Important Information from the Quality Department: Quality Commercials:

9/11/2023:  Provider Newsletter Q3 2023

8/21/2023Medicaid PDMP Reminder

8/18/2023Reminder:  There is a Prior Auth LookUp Tool for J Codes or other HCPCS codes for medications

9/1/2023:    Effective 9/1/23 - Claims submitted with missing, invalid, and incomplete NDC Information will be denied

7/26/2023:  Reminder: Molina has a LookUp Tool for J Codes and other HCPCS codes for medications on our website 

7/1/2023:    Effective 7/1/23: Changes to Prior Authorization Requirements

6/1/2023:    Provider Newsletter - Q2 2023

5/1/2023:    Effective 5/1/23: Fax Size Limitation for Clinical Information

4/1/2023:    Effective 4/1/23: Addition of Residential Rehabilitation Services for Youth (RRSY) Benefit for CHP (Grid)

3/1/2023     Provider Newsletter - Q1 2023

3/1/2023:    Effective 3/1/23: Changes to Prior Authorization Requirements

1/1/2023:    Effective 1/1/23 – Grid of Benefit Changes for all Lines of Business

1/1/2023:    Provider Net Sunsetting Notice

1/1/2023:    Effective 1/1/23 – Molina will no longer accept claims submitted via non-approved submission pathways


12/2/2022:  Q4 2022 Provider Newsletter

12/2022:    Implementation of new payment platform through ECHO Health complete

10/1/2022: Effective 11/1/22: Change to PA Requirements for PT/OT/ST

10/1/2022:  Effective 11/1/22: Change to PA Requirements for Home Care 

6/2022:       Pharmacy Real-Time Prescription Benefits Tool Now Available

5/25/22    New MCG AutoAuth Process– Advanced Imaging

                      - Availity Portal Instructions  

                      - Legacy Portal Instructions 

2/1/22     Adult BH HCBS transition to CORE

1/1/22 -   Beacon Health Benefits End for Downstate Affinity by Molina Healthcare Members

1/24/22     Additional Provider Education - Services Provided to Children/Youth in Foster Care

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)

Effective 4/1/21: Molina Partners with Locus Calocus
Effective 4/1/21: Q2 Prior Auth Updates
Effective 4/12/21: Removal of Knee Replacement Procedure Code
Effective 3/1/21: Molina Partners with MCG Health

Provider Newsletters (prior editions)

Q3 2022 Provider Newsletter

Q1 2022 Provider Newsletter

Q4 2021 Provider Newsletter

Q3 2021 Provider Newsletter

Q2 2021 NCQA Provider Newsletter

Q1 2021 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