May Managed Care Plan Updates
This past month CareSource, and Molina have published a variety of updates around events and policy changes impacting their organizations. View below a comprehensive overview of the activity taking place at each of the managed care plans for Medicaid.
- Nurse Home Visits: As of Jan. 1, 2022, CareSource’s Maternal and Infant Support Program (MISP) will start covering nurse home visits. Nurse home visitors will need to be certified to provide nurse home visiting services in alignment with the Ohio Department of Health’s (ODH) Help Me Grow rules in OAC 3701-8. Pregnant individuals are also eligible for 30 visits per year. Click here to read full policy.
- Pediatric Speech-Language Therapy: Effective July 7, 2022 CareSource requires outpatient speech language pathology services to meet medical necessity criteria for members under the age of 21 years. Click here to read the fully policy.
- CareSource’s June Provider Orientation and Education Live Webinar: CareSource’s Health Partnership team will host their first quarterly Provider Orientation Webinar on June 10 at 12:30 p.m. CareSource’s will be sharing current and pressing topics for 2022. Chip Neilson AVP, Health Partner will also be discussing “What’s New in the Next Generation Ohio Medicaid”. Learn more and see how to register.
- Clinical Policy Website: Molina recently launched an online provider tool for clinical policies; a new, dedicated website at MolinaClinicalPolicy.com. The website includes Molina Clinical Policies (MCPs) and Molina Clinical Reviews (MCRs), which are used by providers as well as Molina’s Medical Directors and internal reviewers to make medical necessity determinations. The website will ensure that providers have access to the most current MCPs and MCRs. Routine updates will be made following approval by the Molina Clinical Policy Committee. We are excited to share this new tool with our providers.
- Revenue Codes Billing Update: Effective May 1, 2022, revenue codes that require a Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code for outpatient services submitted without the required codes will be denied. This update is in accordance with ODM Hospital Billing Guidelines, Appendix I – Covered and Non-Covered Revenue Codes. Find the Hospital Billing Guidelines at medicaid.ohio.gov, under “Resources for Providers,” select “Billing,” then under “ODM Hospital Billing Guidelines” select “For Dates of Discharge and Dates of Service On or After 9/1/2021.”