MedicaidAdministrativeHigh impact
05-12-2026 Quality Measures for Encounter Data Update: Quality Measures for Encounter Data 2.0 – APL 26-003 IE LA SAC SD
Molina Healthcare·CA·Quality Measures
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California has implemented new Quality Measures for Encounter Data 2.0 requirements for Medi-Cal providers, effective January 1, 2026. Providers must ensure encounter data submissions meet strict performance thresholds including 120-day submission deadlines, duplicate encounter limits, and denial correction requirements to avoid financial sanctions starting July 1, 2027.
Action Required
Immediately: Review and implement Quality Measures for Encounter Data 2.0 requirements. Billing team must ensure all encounter submissions to Molina meet performance thresholds: submit encounters within 120 days of service (90% minimum), keep duplicate encounters below 0.5%, maintain corrected denied encounters above 99.5%, and correct denied encounters within 15 days (97.5% minimum). Update billing system workflows and monitoring processes to track these metrics. Failure to meet thresholds may result in corrective actions and financial sanctions starting July 1, 2027.