Payment Integrity Policies
Molina Healthcare of OH Payment Integrity Payment Policies
For Molina Healthcare Active Medicare and Marketplace, Please click the link.
Molina Healthcare Medicare and Marketplace Payment Integrity Payment Policies- Add-on Coding
- Co Surgeon Team Surgeon Professional
- Critical Care Codes when Discharging Home from the Emergency Department
- Decision for Surgery Modifier 57
- Diagnosis Code Coding
- Global Surgical Packages for Professional Providers
- Hydrolyzed Enteral Formula Diagnosis
- ICD-10 First Listed Diagnosis Coding Policy
- ICD-10 Specificity Coding Policy
- Injection and Infusions in the ER with 25 Modifier
- Inpatient services billed on Outpatient bill types
- Medically Unlikely Edits
- Modifier 25
- Modifier 26
- Modifier KX
- Modifier TC
- Multiple EM codes for the same provider same date of service
- NCCI PTP with Modifiers
- Reduced Services and Discontinued Procedures
- Therapy Modifier Coding
- Unspecified Codes in an Inpatient Setting
- Appropriate Level of Care Reimbursement
- Breast Cancer Genetic Testing Tier 1 vs Tier 2
- DRG Clinical Validation
- Excludes 1 Note
- Facility Emergency Department Evaluation and Management leveling
- Hospital Routine Supplies Services
- Optum Pause and Pay
- Newborn and NICU
- NF Ventilator Pre-Payment Medical Necessity Review
- Non-Invasive Prenatal Testing
- Observation
- High Level Evaluation and Management with Preventive Medicine
- Psychotherapy Add On with High Level EM
- Readmission
- Sepsis
- Split-Night-Sleep-Study
- Ambulance Modifier
New-Pending Policies
Existing Policies