Payment Integrity Policies
Molina Healthcare of AZ 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
- Anesthsia 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
- 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