Updates and Bulletins


Availity

 

icon Availity Appeals and Reconsideration Changes      
icon Availity Update: Prior Authorization Requirements Effective: 3/1/2025
icon Managing Claims in Availity (Appeals, Reconsideration Inquiries, and Corrected Claims)     
icon Availity Update: Prior Authorization Application Update Effective 12/9/202
icon Submit and Track Your Appeals on Availity Essentials
icon Availity Portal Instructions

 

icon Q1 2025 Provider Newsletter
icon Q4 2024 Provider Newsletter
icon Q3 2024 Provider Newsletter
icon Q2 2024 Provider Newsletter
icon Q1 2024 Provider Newsletter

 

icon Changes to Prior Authorization Requests Effective July 1, 2025
icon Guidelines Update In-Home Sleep Studies for Obstructive Sleep Apnea (OSA) Diagnosis
icon Changes to Prior Authorization Requirements Effective: 3/1/25
icon Continuing Medical Education Credits, Sign Up for February 25, 2025 
icon Unblocking Molina Healthcare Fax Numbers for UM Communications
icon Effective 11.19.24 Provider Office Laboratory Testing (POLT) - Additional Codes Added
icon Providers' Member Rewards Incentive Flyer
icon Changes to Prior Authorization Requirements Effective:1/1/2025
icon Trauma-Informed Care for Children/Youth in Foster Care
icon Claims for Genetic Testing Services During Pregnancy
icon OASAS Change Opioid Treatment Program
icon TMS Provider Benefit Notification Form
icon NYS Medicaid ID Rules (April 2024)
icon Quality Commercial Health Overview (May 2024)
icon MCG 28th Edition Goes Live (April 16, 2024)
icon Optum-Change Healthcare Outage Update (April 5, 2024)
icon SBMH Clinic Rate Enhancement, Timely Filing
icon Children's HCBS Authorization and Care Manager Notification Form
icon Optum-Change Healthcare Outage update (March 18, 2024)
icon Effective April 1 2024 Essential Plan 200 250 Provider Notification
icon 2/29/24: Optum-Change Healthcare Outage Update
icon 2/26/24: Optum-Change Healthcare Outage
icon FAQ- Optum Pause & Pay Program
icon Effective March 1, 2024: Services in link are allowed in all Network Physician’s Office Setting
icon March 2024 Quality Commercial
icon February 2024 Quality Commercial
icon January 2024 Quality Commercial
icon Provision and Coordination of Services for Children/Youth in Foster Care
icon Important Information from the Quality Department: Quality Commercials:
icon 2/1/24: Molina General Provider Notice of Health Map
icon 2/1/24: EDSD Guidance for Providers
icon 1/1/24: Child Health PLUS Expanded Benefits to include Home and Community Based Services (HCBS)

 

Archive—Provider Newsletters

 

icon Q4 2023 Provider Newsletter
icon Q3 2023 Provider Newsletter 
icon Q2 2023 Provider Newsletter
icon Q1 2023 Provider Newsletter

icon Q4 2022 Provider Newsletter
icon Q3 2022 Provider Newsletter
icon Q2 2022 NCQA Provider Newsletter
icon Q1 2022 Provider Newsletter

icon Q4 2021 Provider Newsletter
icon Q3 2021 Provider Newsletter
icon Q2 2021 NCQA Provider Newsletter
icon Q1 2021 Provider Newsletter 

icon 2020 Q4 MHNY Provider Newsletter
icon 2020 Q3 MHNY Provider Newsletter
icon 2020 Q2 NCQA Provider Newsletter
icon 2020 Q1 Provider Newsletter

icon 2019 Q4 Provider Newsletter
icon 2019 Q2 NCQA Provider Newsletter
icon 2019 Q1 Provider Newsletter

icon Provider Bulletin- NICU Payment Review Policy 
icon Provider Bulletin- MHNY Provider Letter Fertility Benefits
icon Provider Bulletin- MHNY Provider letter Children's Carve In
icon Provider Bulletin- June 2019: New Appeal Request Form

 

 

icon11/28/23: Enhancement to Reporting of Refunds on EOPs
icon 9/1/23: Effective 9/1/23 - Claims submitted with missing, invalid, and incomplete NDC Information will be denied
icon 8/21/23: Medicaid PDMP Reminder
icon 8/18/23: Reminder: There is a Prior Auth Lookup Tool for J Codes or other HCPCS codes for medications
icon 7/26/23: Reminder: Molina has a Lookup Tool for J Codes and other HCPCS codes for medications on our website 
icon 7/1/23: Effective 7/1/23: Changes to Prior Authorization Requirements
icon 5/1/23: Effective 5/1/23: Fax Size Limitation for Clinical Information
icon 4/1/23: Effective 4/1/23: Addition of Residential Rehabilitation Services for Youth (RRSY) Benefit for CHP (Grid)
icon 3/1/23: Effective 3/1/23: Changes to Prior Authorization Requirements                    
icon 1/1/23: Effective 1/1/23 – Grid of Benefit Changes for all Lines of Business
icon 1/1/23: Provider Net Sunsetting Notice
icon 1/1/23: Effective 1/1/23 – Molina will no longer accept claims submitted via non-approved submission pathways
icon October 2023
icon November 2023
icon December 2023

 

icon 12/22: Implementation of new payment platform through ECHO Health complete
icon 10/1/22: Effective 11/1/22: Change to PA Requirements for PT/OT/ST
icon 10/1/22: Effective 11/1/22: Change to PA Requirements for Home Care 
icon 6/1/22: Pharmacy Real-Time Prescription Benefits Tool Now Available
icon RTB Information at Point of Care Document
icon Real-Time Prescription Benefits Access and Onboarding Handbook
icon 5/25/22: New MCG AutoAuth Process– Advanced Imaging
icon 2/1/22: Adult BH HCBS transition to CORE
icon 1/24/22: Additional Provider Education - Services Provided to Children/Youth in Foster Care
icon 1/1/22: Beacon Health Benefits End for Downstate Affinity by Molina Healthcare Members
icon Provider FAQs - Beacon Transition 
icon General Provider Notice - Beacon Transition

 


icon 11/1/21: Molina Healthcare of New York, Inc. will partner with Progeny Health, LLC
icon 10/1/21: Applied Behavioral Analysis Benefit (ABA) - Changes in Prior Auth Codes
icon 9/1/21: Prior Auths will transition back to Molina (away from eviCore)
icon 4/1/21: Molina Partners with Locus Calocus
icon 4/1/21: Q2 Prior Auth Updates
icon 4/12/21: Removal of Knee Replacement Procedure Code
icon 3/1/21: Molina Partners with MCG Health

 

icon Crisis Residence Services - Effective 12/1/20
icon COVID Payment Policy (when rates are unavailable)
icon Mock HEDIS Audit - 10/5-12/11
icon New Drug and Biological Pre-Payment Code Edits - Effective 11/24/20
icon Reduction in PA Codes - Home Health Services - Effective 10/1/20 * CDC Guidelines
icon Molina itemized billing effective 7/15
icon New Prepayment Claims Review beginning 6/30/20
icon Patient Cost-Sharing for Laboratory Tests to Diagnose COVID-19
icon Coronavirus: Utilization Review and Emergency Admission Notification
icon New Prepayment Claims Review
icon COVID-19 Telehealth Billing
icon Coronavirus Provider FAQ
icon eviCore New Prior Authorization Requirements Effective 4/1/20
icon Coronavirus Talking Points for Providers
icon Pre Pay Audit Provider Notification Letter
icon Pharmacy Network Changes Effective 1/1/20
icon eviCore Update
icon eviCore HOLD Notification
icon New Prior Authorization Requirements through eviCore Mobile Health Spot
icon Member Incentive Program
icon New Prior Authorization Requirements through eviCore


icon Changes to Prior Authorization Requirements effective 10/01/2019
icon Prior Authorization Update_SPA Services
icon Provider Update: Review of Sepsis and Septic Shock

 

 


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