01/08/2019

Managed Care Committee Reimbursement TIDBITS

Featuring this month: Molina Healthcare of Michigan

TidBits thanks to 

MSHO Managed Care Committee Member

ASHLEY OCHOA 

Did you know...When calculating the units for a drug authorization, Molina requires the waste to be included in the requested authorized units.

Example:

• Pt is receiving 705mg Herceptin, SDV is 150mg HCPC unit 10mg, auth should be for 75 units q 21 days
• Form does not indicate this information is needed. Buy and Bill is available, but also not indicated on the form.

Did you know... Drugs added to the authorization list for DOS after October 1, 2018: C9014, C9015, C9016, C9024, C9028, C9029, J0565, J0604, J0606, J1428, J1555, J1627, J2326, J2350, J 3358, J7210, J7211, J9022, J9023, J9203, J9285, Q2040

Did you know... Molina’s provider portal is very user friendly. Helpful feature: authorization tab offers a way to look up the remaining available units of a patients authorization, including medically billed drugs.

Visit their website ... CLICK HERE

NOTE: A different Michigan Payer will be featured monthly.

 Visit the MSHO Website for a listing of the Michigan Health Plans and the MSHO Managed Care Committee.

CLICK HERE