Medicare AdvantageAdministrativeHigh impact
[Ohio] Corrected Claim Submission Requirements
CareSource·OH·Claims & Billing
Effective date
Apr 11, 2025
We identified it
May 9, 2026
Summary
CareSource has issued corrected claims submission requirements for Ohio providers across D-SNP, Marketplace, Medicaid, and MyCare plans. Key requirements include: submitting corrected claims only through appropriate channels (Availity or EDI), always including the most recent claim number as the Original Reference Number, and submitting corrected claims within 365 calendar days of the original remit date. Corrected claims without the latest claim number iteration will be systemically rejected.
Action Required
Effective immediately (Notice Date April 11, 2025): Billing team must implement the following changes: (1) Configure billing software to enforce use of the most recent claim number (not the original) when submitting corrected claims; (2) Remove any workflows that submit corrected claims through claim dispute/reconsideration processes and redirect all corrected claims to Availity (for D-SNP, Marketplace, MyCare) or ODM-authorized EDI trading partners (for Ohio Medicaid); (3) Establish internal process to track the 365-calendar-day submission deadline for corrected claims from the remit date and flag any claims approaching this deadline; (4) Update staff training materials to emphasize that missing or incorrect claim number iterations will result in automatic system rejection; (5) Audit current corrected claim submission practices and correct any pending submissions that lack the latest claim number iteration. Failure to comply will result in corrected claims being systemically rejected and duplicate claim denials.