Medicare AdvantageAdministrativeHigh impact
07-01-2026 Billing Reminder SNF, ICF DD and Subacute Care Facilities IM IE LA SAC SD
Molina Healthcare·CA · Geriatrics, Palliative Care·Claims & Billing
Effective date
Jul 1, 2026
We identified it
Jul 7, 2026
Summary
Molina Healthcare of California issued a billing reminder (effective July 1, 2026) for SNF, ICF-DD, and Subacute Care facilities highlighting four common claim denial reasons: duplicate service billing, missing authorization, enrollment discrepancies, and invalid revenue codes. The bulletin emphasizes pre-submission verification of authorization, member eligibility, and revenue code accuracy to reduce denials and processing delays.
Action Required
By July 1, 2026: Billing team must implement four preventive measures: (1) Verify member eligibility in the Molina provider portal (Availity Essentials) before rendering services and before claim submission; (2) Obtain and verify all required authorizations before billing and include authorization numbers on all claims; (3) Cross-check claim status through provider portal inquiry before resubmitting to prevent duplicate service billing; (4) Validate revenue codes against current billing guidelines and payer-specific manuals to ensure alignment with services rendered. Update billing workflows to include pre-submission checklists for all three facility types (SNF, ICF-DD, Subacute Care). Failure to implement these controls will result in continued claim denials and payment delays. Assign responsibility to billing team members with access to Availity Essentials and EMR systems.