OhioRISE billing for youth behavioral health providers

OhioRISE is Ohio Medicaid's specialized managed care program for children and youth with significant behavioral health needs, administered by Aetna Better Health of Ohio. Its claims follow different rules than the regular plans, and that is where many providers lose money.

Why OhioRISE billing is different

A young person in OhioRISE is usually also enrolled in a regular Medicaid managed care plan. Some services are billed to OhioRISE and others still go to the member's regular plan. Sending a claim to the wrong one is one of the most common causes of OhioRISE-related denials.

OhioRISE enrollment also changes over time as youth qualify for the program or leave it. Checking enrollment before each billing cycle keeps claims from going to a plan that no longer covers the member.

What we handle for OhioRISE providers

• Eligibility checks for OhioRISE and the member's regular managed care plan before each cycle
• Claim build and submission to Aetna Better Health of Ohio for OhioRISE services
• Routing the remaining services to the member's regular plan
• Denial triage and resubmission, with patterns reported back to your team
• Payment reconciliation and A/R follow-up in the same workspace as your other Medicaid billing

Providers we support

Community behavioral health agencies and youth-serving programs that deliver OhioRISE services, such as intensive home-based treatment, care coordination, behavioral health respite and mobile response, alongside their regular Medicaid services.

We bill every Ohio Medicaid managed care plan too, so OhioRISE and the rest of your Medicaid billing stay in one place.

Start with a free A/R review

We'll review your open OhioRISE and managed care claims and show you what's still billable and which denials are worth appealing. Pricing is a small percentage of what you collect, lower than most billing companies.

Frequently asked questions

Who administers OhioRISE?

Aetna Better Health of Ohio administers OhioRISE for the Ohio Department of Medicaid.

Can you bill OhioRISE and the regular Medicaid plans together?

Yes. We bill OhioRISE and every Ohio Medicaid managed care plan from one workflow, and your workspace shows all of them together.

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