This past month CareSource and Humana Healthy Horizons have published updates on events and policy changes impacting their organizations.
- Next Generation of Ohio Medicaid Managed Care: Payer ID Change – UPDATE: In alignment with the Next Generation Managed Care Initiative, CareSource is required to change their Payer ID. The CareSource Payer ID is changing from 31114 to 0003150 for Ohio Medicaid providers only. The new Electronic Data Interchange (EDI) will be implemented on Feb. 1, 2023 for claims only. The new EDI will not accept Prior Authorizations (PA) until Stage 3b is implemented. The Provider Network Management (PNM Portal) will not accept claims or PAs until Stage 3b is implemented by Ohio Department of Medicaid (ODM). Providers must reflect the CareSource Payer ID change when submitting claims with a Date of Service on or after Feb. 1, 2023. The Date of Service to input the new CareSource Payer ID for submitting PAs through the new EDI and submitting claims and PAs through the PNM Portal will be defined by ODM. Click here to read the update in detail.
Humana Healthy Horizons Update:
- Humana Healthy Horizons Payer ID: On Page 44 of Humana Healthy Horizons Provider Manual they reference 61103 as their fee-for-services payer ID. Click here to read all claims information for Humana.
AmeriHealth Caritas Update:
- AmeriHealth Caritas Payer ID: On slide 15 of the AmeriHealth Caritas overview presentation AmeriHealth listed their payer IDs to use for billing starting February 1, 2023.