Payment Integrity Policies
Molina Healthcare Of ID Medicaid Payment Integrity Payment Policies
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Molina Healthcare Medicare and Marketplace Payment Integrity Payment Policies- Anesthsia Bundling
- Colonoscopies and Sigmoidoscopy
- Co Surgeon Team Surgeon Professional
- 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
- Multiple EM codes for the same provider same date of service
- NPFS Status Indicator T
- Modifier 26
- Modifier KX
- Molecular Pathology
- Non-Invasive Abdominal/Visceral Vascular Studies
- Polysomnography Studies and Home Sleep Testing
- Psychotherapy Add On with High Level EM
- Pulmonary Function Testing
- 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
- ICD-10 Specificity Coding Policy
- ICD-10 First Listed Diagnosis Coding Policy
- Newborn and NICU
- Readmission
- Sepsis
- Split-Night-Sleep-Study
- Overlapping Room and Board
- Optum Pause and Pay
- Observation