Ohio Medicaid managed care billing for behavioral health

Most Ohio Medicaid members are enrolled in a managed care plan, and each plan has its own portal, edits and denial habits. We bill all of them for behavioral health providers, so you don't have to learn seven sets of rules.

Plans we bill

• CareSource
• Buckeye Health Plan
• Anthem Blue Cross and Blue Shield
• Molina Healthcare of Ohio
• UnitedHealthcare Community Plan of Ohio
• Humana Healthy Horizons in Ohio
• AmeriHealth Caritas Ohio
• OhioRISE, administered by Aetna Better Health of Ohio (see OhioRISE billing)

Where managed care billing goes wrong

Plan switches. Members change plans, and a claim sent to the old plan is denied even though the service was covered. We verify eligibility before each billing cycle and route each claim to the plan the member is enrolled in on the date of service.

Plan-specific edits. The same H-code can be accepted by one plan and rejected by another because of a modifier, place of service, unit count or diagnosis pointer. We keep the edits we've learned from each plan's denials and check claims against them before submission.

Silent rejections. A claim rejected at the front door never shows up as a denial, so it ages until it can no longer be billed. We confirm every batch's acknowledgments and claim acceptance, not just that a file was sent.

Underpayments. A "paid" claim can be paid at the wrong rate or on fewer units than billed. We reconcile 835 remittance line by line against what was billed, so partial payments get worked instead of written off.

Behavioral health services we bill

Community psychiatric supportive treatment (CPST), therapeutic behavioral services, psychosocial rehabilitation, peer recovery support, counseling and therapy, SUD case management, and SUD intensive outpatient and partial hospitalization, including per-diem and statement-period claims.

Start with a free A/R review

We'll look at your open claims across every plan and give you a one-page list of what's still billable, what is close to its filing deadline, and which denials are worth appealing. Then we charge a small percentage of what you collect, lower than most billing companies.

Frequently asked questions

Do I need a separate biller for each Medicaid plan?

No. We bill every Ohio Medicaid managed care plan and OhioRISE from one workflow, and your workspace shows all of them together.

What happens when a member switches plans?

We check eligibility before each billing cycle and send each claim to the plan the member was enrolled in on the date of service. Claims already denied for the wrong plan are rebilled to the correct one.

More billing services