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May 2024 Managed Care Plan Updates

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

Ohio Department of Medicaid: 

The Ohio Department of Medicaid’s OhioRISE program is a specialized managed care program for youth with complex behavioral health and multisystem needs. If you have patients or families that need more information about the OhioRISE program, point them to the Resources for Members and Families webpage which has everything they need to know!

 

AmeriHealth Caritas: 

Removal of prior authorization for certain services is part of AmeriHealth Caritas’ continued efforts to make the prior authorization process more efficient and transparent. Beginning 4/24/24, certain procedure codes do not require prior authorization. To view this update, click here.

For the most efficient review of your pharmacy requests, please use the information found here to ensure you are submitting your prior authorization for physician administered drugs to the correct area for review.

 

CareSource: 

The Ohio Market Provider Relations team is excited to announce the 2024 Quarter 2 Live Provider Education and Training Series for all Ohio providers. Each of the Provider Education and Training topics will be interactive and informative, offering providers an opportunity to engage in more in-depth training on CareSource programs, provider resources and tools. The intended audience for the event is any new or existing providers in CareSource’s network. To register, please email Elsa.Arriola@CareSource.com.

Ohio’s behavioral health claims are paying at 2023 rates, CareSource is aware that some claims may not be processing at the appropriate rates implemented January 1, 2024. They are working diligently to update their configuration to the appropriate fee schedules and make the decision to pay claims immediately based on the 2023 rates. For more information, click here.

 

Humana Healthy Horizons: 

Humana Health Horizons in Ohio will pay an enhanced reimbursement rate to providers rendering Diabetes Self-Management Education (DSME) and billing the appropriate codes:
G0108 and G0109. Enhanced rates will be paid through 12/31/2024. To learn more, click here.

In Humana’s combined efforts with all Managed Medicaid plans and the Ohio Department of Medicaid to support Ohio Department of Medicaid’s quality strategy and to increase access for appropriate use of CGMs, prior authorization for DexCom and FreeStyle Libre CGMs is being waived through at minimum, 12/31/2024. Click here to learn more.

 

Molina Healthcare:  

As of April 4, 2024, Molina transitioned its direct connection with ECHO (an Optum-CHC partner). Molina has reestablished a direct connection with Optum-CHC to resume provider payments via the pre-outage processes. Payments are current and will continue to be processed in the order received. To learn more, click here.

 

Buckeye:

Buckeye has published updates regarding Medicaid prior authorization changes effective June 1, 2024. Click here to view these changes.

 

United Healthcare:

United Healthcare’s CommunityCare Portal can help improve efficiencies within your practice by giving you a single source to view a patient’s total health history, get clinical updates, view redetermination dates and more. Click here to learn more.

Changes are coming soon to United Healthcare’s Provider Portal access. If you use the portal, you’ll need to update your One Healthcare ID authentication options to retain access. Click here to learn more.

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