Medicare AdvantagePrior AuthMedium impact
[Ohio] Temporary Waiver of Prior Authorization Requirements for Nursing Home Admissions from Hospital No Longer in Effect
CareSource·OH · Geriatrics, Internal Medicine, Palliative Care·Provider Bulletin
Effective date
Mar 10, 2025
We identified it
May 9, 2026
Summary
CareSource's temporary waiver of prior authorization requirements for nursing home admissions from hospital settings has ended. Effective March 10, 2025, all nursing home admissions from inpatient hospital settings now require prior authorization again per standard CareSource authorization policy. Billing teams must resume obtaining prior authorization for these admissions.
Action Required
By March 10, 2025: Billing team and care coordinators must resume obtaining prior authorization for all nursing home admissions from inpatient hospital settings. Update internal workflows and admission protocols to remove any temporary expedited processes that bypassed prior authorization. Train staff that the temporary waiver has expired and standard authorization requirements are now in effect. Contact CareSource Provider Services with questions: Medicaid/MyCare 1-800-488-0134, Marketplace 1-833-230-2101, D-SNP 1-833-230-2176. Failure to obtain prior authorization will result in claim denials.