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All Molina Contracted providers: Lab Issue
To all Molina providers who have been affected by the lab issue: Molina has reported that they will not be reprocessing the lab charges that were denied due to their change of policy (see Provider News Bulletin, corrected version, February 6 2018). San Juan IPA has notified Molina that we see this as a breach of contract issue, and as a result of this and other issues with the payer the IPA has seen member terminations.
Though we do see this as a breach of contract issue, we also recognize that it only affects a small number of our member practices and therefore we are not issuing a network termination. At this time Molina has not been successful in their Centennial Care 2.0 appeal (though I believe it’s ongoing) and they have a very small footprint with the Marketplace product. We have opted to hold on any action into 2019 and wait to see what will happen with the payer in this market. It may very well be that the issue is self-
Please contact the IPA with any questions about this matter. Thank you.
Chief Executive Officer
San Juan IPA and Affiliates