Payment Integrity Policies
Molina Healthcare of VA 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
- Critical Care Codes when Discharging Home from the Emergency Department
- Decision for Surgery Modifier 57
- Diagnosis Code Coding
- Discontinued Procedures
- Global Surgical Packages for Professional Providers
- Hydrolyzed Enteral Formula Diagnosis
- ICD-10 First Listed Diagnosis Coding Policy
- ICD-10 Specificity Coding Policy
- Medically Unlikely Edits
- Modifier 25
- Modifier 26
- Modifier KX
- Modifier TC
- 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
- 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