[Ohio] Important Information on Provider Types, Specialties and Billing Codes

REQUIREMENTS: Before January 1, 2026: - Billing team must audit all current home health service billing to ensure provider type and specialty align with services billed. Review OAC Chapter 5160-32 and the Ohio Medicaid Electronic Visit Verification Program and Service Code Guide. - Billing team must verify all billing codes used for EVV-subject services comply with OAC requirements and match the submitting provider's specialty designation in the billing system. - Update billing system validation rules to prevent submission of services that do not align with provider specialty (e.g., block CPT codes that are inappropriate for the registered specialty). - Notify all home health providers of the January 1, 2026 enforcement date for specialty-code matching; advise that claims with inappropriate service codes for provider specialty will be rejected. - For MyCare Ohio providers: Stop billing through Aetna Better Health of Ohio (no longer participating in EVV programs). Verify patient transitions to Anthem (new payer) or other active MyCare Ohio plans. Remove United Healthcare from active MyCare Ohio panels. Consequences of inaction: Claims will be rejected with "disallow inappropriate service for provider specialty" denial reason, resulting in payment delays and revenue loss.