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January 25, 2024
February 2024 Managed Care Plan Updates

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

 

All Ohio Medicaid Managed Care Plans

The Ohio Medicaid Managed Care Organizations (MCOs) Consolidated Resource Guide was released in January 2024. Key updates as it relates to well-visit appointments include:

  • Well visits can now be scheduled every calendar year for members of all Ohio Medicaid Managed Care Plans. This allows members and providers to schedule well visits when it’s convenient and removes the barrier of the previous policy that required 365 days between well visits.
  • All Ohio Medicaid Managed Care Plans will reimburse for a well visit completed on the same day as a sick visit. The well visit and sick visit will both be paid at 100% with the addition of a modifier 25.

 

CareSource

The CareSource Health Partnerships team has announced their 2024 Quarter 1 Live Provider Education and Training Series for all Ohio Providers. View these education opportunities here.

 

Molina

Providers now have access to a new process for submitting the following appeals to Molina in the Availity Essentials Portal:

  • Authorization reconsideration (clinical claim dispute)
  • Claim reconsideration (non-clinical claim dispute)

Through the portal, providers can check the status of a request, view and import requests in Availity that were initiated through outside channels (i.e. fax), upload supporting documentation, and receive a notification when requests have been finalized and processed by Molina. Contact OHProviderRelations@MolinaHealthcare.com with questions.

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