Payment Integrity Policies
Molina Healthcare Medicare and Marketplace Payment Integrity Payment Policies
For Molina Healthcare Active Medicare and Marketplace, Please click the link.
Molina Healthcare Medicare and Marketplace Payment Integrity Payment Policies- New-Pending Emergency E/M Codes and Place of Service 23
- New-Pending Incarceration Diagnosis Code
- New-Pending Hospice Value Code 61
- Hydrolyzed Enteral Formula Diagnosis
- Medically Unlikely Edits
- NPFS Status Indicator T
- Modifier 26
- Modifier KX
- Non-Invasive Abdominal/Visceral Vascular Studies
- Psychotherapy Add On with High Level EM
- Therapy Modifier Coding
- Unspecified Codes in an Inpatient Setting
New-Pending Policies
Existing Policies
- New-Pending Diagnosis Code Y65.XX
- New-Pending Optum EDC Analyzer - Facility ER E/M Leveling Prepayment
- Appropriate Level of Care Reimbursement
- 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
- High Level Evaluation and Management with Preventive Medicine
- Hospital Routine Supplies Services
- ICD-10 Specificity Coding Policy
- ICD-10 First Listed Diagnosis Coding Policy
- Sepsis
- Split-Night-Sleep-Study
New-Pending Policies
Existing Policies
- Corrected Claims
- Duplicate Claims
- General Coding
- Post Pay General
New-Pending Policies
Existing Policies
New-Pending Policies
Existing Policies
- New-Pending ESRD Billing for J0406 or J0606 with Modifier AX
- New-Pending ESRD Consolidated Billing
- New-Pending ESRD 90999 No Modifer (Weekly and Monthly) Limits
New-Pending Policies
Existing Policies
- Ambulance Modifier
New-Pending Policies
Existing Policies
- New-Pending Electrocardiographic EKG or ECG Monitoring Holter or Real Time Monitoring
New-Pending Policies
Existing Policies