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South Central / Southeast Region
July 7, 2022
July Managed Care Plan Updates

This past month, CareSource and Molina have published updates on events and policy changes impacting their organizations.

CareSource Updates

  • Extended Payment Plan or Settlement Update: In accordance with the Ohio Department of Medicaid provider agreement, effective October 1, 2022, CareSource will consider requests for an extended payment plan or settlement when overpayment recoveries are identified. Providers will have the option to submit a payment plan request to CareSource to provide re-payments on a set schedule when overpayments have occurred. Providers will also have the option to request a settlement on claims that have been identified as overpaid and provide a lump sum check for the identified overpayment amount.  Click here to read the policy update in detail.
  • Upload Claim Submissions Seamlessly in Provider Portal: CareSource has created a new process to allow providers to upload UB04 and HCFA claims using their Provider Portal on the CareSource website rather than submitting claims via mail. Submitting claims through the Provider Portal allows groups the ability to upload completed paper claims for processing which will process the claim faster and provide claim status.  This will also reduce administrative costs and probability of errors or missing information. Click here to read the update in more detail.

Molina Updates

  • Notice of Changes to Prior Authorization (PA) Requirements: Molina has updated its Prior Authorization (PA) Code List effective July 1, 2022. The updates can be viewed on Molina’s Provider Website, under the “Forms” tab, under “Prior Authorization Code List” and reference the “2022 Q3 PA Code Changes 7-1-2022”. In this update, Molina has indicated non-covered codes, new codes that require PA, replacement codes, and the codes that no longer require PA for all lines of business.  Click here to read about the update on Molina’s Provider Bulletin.

 

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