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West Region
August 2, 2023
August 2023 Managed Care Plan Updates

This past month, the managed care plans have published updates on events and policy changes impacting their organizations.

AmeriHealth Caritas Updates: 

  • Defects impacting delivery of 835 files: Ohio Department of Medicaid (ODM) is aware of issues affecting the provider community’s ability to consistently receive fee-for-service (FFS) 835 files since the Fiscal Intermediary (FI) launch on February 1. ODM understands the importance of timely and accurate data exchange and is committed to ensuring a smooth and reliable user experience. Over the last few months, ODM and its vendors have been identifying and correcting 835-related errors. As a result of the fixes, the majority of missing 835 details have been generated. A large batch was released on May 24, followed by a second batch released on June 26, and another on July 7. Click here to read more about this issue.
  • Billing evaluation and management services with behavioral health evaluation codes: In an effort to reduce administrative burden and expand access to behavioral health services, AmeriHealth Caritas will reimburse claims for evaluation and management services and behavioral health evaluations, when the level of care warrants the usage of the behavioral health evaluation and documentation supports that these services are separately identifiable, in accordance to Ohio Administrative code 5160-27.03 and Appendix A, 5160-27-03. Click here to read more about this update and billing.

CareSource Update:

  • UPDATE – Rejection of Claims that Bypass the ODM Fiscal Intermediary: CareSource is updating the reject code from 585 “Denied Charge or Non-Covered Charge” to reject code – 506 “Entity is changing processor/clearinghouse”. As of June 27, 2023, this claim must be submitted to the new processor/clearinghouse. For more information, please visit ODM’s website and read the full CareSource update here.
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