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

CareSource: 

Providers may request private duty nursing services and home health services for greater than 60-day period for members with chronic conditions as CareSource does not apply a hard limit of 60 calendar days to private duty nursing and home health authorization periods. To learn more click here.

Humana Healthy Horizons: 

Since the Feb. 1, 2023, launch of the Electronic Data Interchange (EDI) providers have experienced issues with the claim submission process. The Ohio Department of Medicaid (ODM) also acknowledges this and is working diligently with its vendors to resolve system challenges and improve the provider experience. Humana is extending timely filing on Ohio Medicaid claims with dates of service on or after (Feb. 1, 2023) until September 30, 2024.Please note there is no change to the dispute timeline. Providers may file a written dispute no later than 12 months from the date of service or 60 calendar days after the payment, denial, or partial denial of a timely dispute submission, whichever is later. To learn more click here.

Molina Healthcare:  

The Ohio Department of Medicaid (ODM) has partnered with IPRO, an external quality review company, to conduct provider surveys between July and September 2024. Molina appreciates your participation in these important survey activities. To learn more, click here.

United Healthcare:

Improving health equity for patients is crucial to help ensure they have access to the resources they need for a healthy life, which include transportation, food and housing. One of the ways providers can help bridge health equity gaps is through health care technological innovations.

Complete UHC’s free CME Driving Health Equity Through Technology and Service Innovation course to learn about the:

• Existing health care technology innovations that can help improve health equity for underserved patients
• Changing landscape of provider coverage and reimbursements as it relates to these innovations

Addressing these social drivers of health is key to reducing health disparities and promoting equitable health outcomes for all communities.