Updates and Bulletins

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

March 2024 Quality Commercial

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

Legacy 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


4/1/21: Q2 Prior Auth Updates


4/12/21: Removal of Knee Replacement Procedure Code


3/1/21: Molina Partners with MCG Health

Provider Newsletters (prior editions)

Q3 2022 Provider Newsletter

Q2 2022 NCQA 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

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- 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