Payment Integrity Policies
Molina Healthcare Medicaid 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
- Anesthesia Bundling
- Colonoscopies and Sigmoidoscopy
- Co Surgeon Team Surgeon Professional
- Critical Care Codes when Discharging Home from the Emergency Department
- Decision for Surgery Modifier 57
- Diagnosis Code Coding
- Diagnosis Code Y65.XX
- Discontinued Procedures
- Emergency E&M Codes and Place of Service 23
- Global Surgical Packages for Professional Providers
- Hydrolyzed Enteral Formula Diagnosis
- ICD-10 First Listed Diagnosis Coding Policy
- ICD-10 Specificity Coding Policy
- Incarceration Diagnosis Code
- 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
- Modifiers XE XS XP XU and 59 Usage
- Facility Bilateral or Anatomical Modifier Use
- Multiple EM codes for the same provider same date of service
- Multiple Procedure Payment Reduction
- NCCI PTP with Modifiers
- Non-Invasive Abdominal/Visceral Vascular Studies
- NPFS Status Indicator T
- Physical Therapy Max Units Per Day
- Podiatric Q Modifiers
- PT/OT Initial Evaluations
- PT/OT/ST Yearly Limit
- Reduced Services and Discontinued Procedures
- Repeat Procedure Modifiers 76 77
- Status Indicator Flag B Bundled Codes
- Tendon Injections Missing Diagnosis
- Therapy Modifier Coding
- Unlisted 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
- DRG Clinical Validation
- Excludes 1 Note
- Facility Emergency Department Evaluation and Management leveling
- Hospice Value Code 61
- Hospice >
- Hospital Routine Supplies Services
- Optum Pause and Pay
- Newborn and NICU
- Non-Invasive Prenatal Testing
- Observation
- Optum EDC Analyzer Facility ER EM Leveling Prepayment
- Overlapping Room and Board
- High Level Evaluation and Management with Preventive Medicine
- Polysomnography Studies and Home Sleep Testing
- Psychotherapy Add On with High Level EM
- Readmission
- Sepsis
- Split-Night-Sleep-Study
- Allergy Test
- Lab Codes with Modifiers 59 and 91
- Lab Panel
- Labs Overlapping with Facility
- Molecular Pathology
- Outpatient Definitive Drug Testing
- Packaged and conditionally packaged lab services
- Physician Office Laboratory Testing
- Presumptive and Definitive Drug Testing Limitation
- Respiratory Pathogen Panel Test
- Specimen Validity Testing
- STI Lab Panel Testing
- Advance Beneficiary Notice (ABN) Modifiers GA, GX, GY and GZ
- After Hours and Weekend Care Professional
- Annual Wellness Visit sooner than 11 months following Initial IPPE
- CMS Replacement Codes
- Corrected Claims
- Duplicate Claims
- Fee Schedule
- Interim Hospital Claims
- Medical Supplies Home Health Consolidated Billing
- Member PCP as Attending Provider in a ER Facility Setting
- Molina Healthcare Audit/Recovery: Variable Discount Payments for Providers
- Molina Healthcare: Audit/Recovery for Revenue to CPT Code Review
- Molina Healthcare Audit Recovery for Billed Units
- Molina Healthcare Audit.Recovery for CPT to CPT Code
- Molina Healthcare Audit.Recovery for Diagnosis Codes
- Molina Healthcare Billing Requirements
- Molina Healthcare Cross-Departmental Audit and Recovery
- Molina Healthcare General Coding Policy
- Paid Amount Exceeded Billed Amount
- Post Pay General
- Post-Pay Authorization Audit
- Semiprivate Vs Private Room
- Ambulatory Echocardiograph Monitoring
- Aortography and Peripheral Angiography
- Autonomic Function Testing
- CT (Computed Tomography) of the Abdomen and Pelvis
- Electrocardiographic EKG or ECG Monitoring Holter or Real Time Monitoring
- Image Guided Radiation Therapy Coding
- Pulmonary Function Testing
- Radiology Bone Density
- Radiology for Chest