Liquid paper for corrections is causing the pages of the claims to stick together. Molina is experiencing greater volumes of hard copy claims in which providers use of If the complete procedure (OB ultrasound and interpretation) is provided by the outpatient hospital, the service counts as one ultrasound.The procedure codes must match to be reimbursed.
In these cases, both providers (outpatient hospital and professional) are expected to bill their portion of the service and are expected to bill the same procedure code for the same date of service.
the claim from the outpatient hospital and the claim for the professional interpretation together count as 1 ultrasound).
The intent of Obstetrics ultrasound policy in the Professional Services manual for those providers who are not maternal-fetal medicine specialists, is to allow two complete OB ultrasounds to be performed per pregnancy without the need for hard copy documentation. Please contact Molina Provider Relations (800) 473-2783 or (225) 924-5040 if you have any questions regarding this matter.ĪTTENTION PHYSICIAN AND OUTPATIENT HOSPITAL PROVIDERSĬALCULATING OBSTETRIC ULTRASOUND SERVICE LIMITS:Įffective with date of processing November 2, 2015, fee-for-service (FFS) Medicaid claims processing logic has been updated to reflect the intent of policy related to obstetrical ultrasound procedures. For more CLIA information, please see Appendix A in the Professional Services Provider Manual. for a complete listing of effective dates for the recently added codes. Please note that the claims processing system has been updated and the following Current Procedural Technology (CPT) codes have been added to the codes that require a “QW” modifier for dates of service on or after the associated effective date. These providers are to add the 'QW' modifier to the procedure code for all CLIA waived tests they submit for reimbursement. Providers with waiver or provider-performed microscopy (PPM) certificate types may be paid only for those waiver and/or PPM codes approved for billing by CMS. Those claims that do not meet the required criteria will deny. Solutions at (800) 473-2783 or (225) 924-5040.ĪTTENTION PROFESSIONAL PROVIDERS OF LABORATORY SERVICESĬlinical Laboratory Improvement Amendments (CLIA) claim edits are applied to all claims for laboratory services that require CLIA certification. Regarding any of the following messages, please contact Molina Medicaid
Participation may be verified in Appendix C, available at Which participate in the Federal Rebate Program will be covered by the Medicaid
Of a drug product, please contact the PBM help desk at 1-80.