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

CareSource Update: 

• Public Health Emergency Ending – Updates to Benefits and Rates: Effective May 11, 2023, the Department of Health and Human Services (HHS) plans to end the Public Health Emergency for COVID-19. Beginning May 12, 2023, CareSource will remove certain benefit such as telehealth and expansion of molecular diagnostic testing for influenza. Also CareSource will be implementing some rate changes that were implemented during the pandemic to support members and providers. Click here to review all the changes being made.
• ODM EDI Claims and Bridge Payments for Providers: As part of the Next Generation program transition, ODM developed extensive monitoring and a variety of contingency plans. Specifically, Ohio Medicaid is now initiating extra measures to minimize provider disruption and ensure payment continuity. ODM is taking two steps to assist trading partners and providers with the February 1 and Ohio Medicaid Enterprise System (OMES) transitions: 1) Temporary Redirection of Electronic Data Interchange (EDI) Claims from OMES to the Managed Care Entities (MCEs) and 2) Temporary Bridge Payments. Click here to review this full update.

Molina Update: 

• EOP and 835 Files Refund Reporting Enhancement: On March 1, 2023, Molina made enhancements to the reporting of refunds received that are displayed on an Explanation of Payment (EOP) and 835 files. Refunds received by a provider are reflected on the EOP and 835, reflected on the claim in the refund column on a reversal claim on the EOP, and include a remit message indicating receipt of a refund. If the refund received is a partial refund, a balancing adjustment claim ending in A is created to balance the reversal, ensuring no recoupment. Click here and scroll to the top of page two to review the full update.
• Appeals and Grievances (A&G) Mailing Address Update: Effective May 1, 2023, the Molina of Ohio Appeals and Grievances team will begin using a centralized mailroom. The new mailing address for the centralized mailroom is documented below. Click here and scroll to the middle of page three to review the full update.
  • • • Molina Healthcare of Ohio, Inc.
        Grievance and Appeals Unit
        PO Box 182273
        Chattanooga, TN 37422