MedicaidAdministrativeMedium impact
[Ohio] December 2025 Policy Updates
CareSource·OH · Gastroenterology, Critical Care, OB-GYN +3 more·Medical Policy
Effective date
Feb 1, 2026
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid released a comprehensive revision to 15 policies effective February 1, 2026, covering administrative, medical, and reimbursement changes. This is a revised notification (originally posted December 1, 2025) with updates highlighted in red. Billing teams must review each specific policy document to identify detailed changes and implement necessary workflow updates before the effective date.
Action Required
By January 31, 2026: Billing team must access each of the 15 revised policies on CareSource.com (Providers > Tools & Resources > Provider Policies) and review the red-highlighted changes. Specifically review: AD-1340 (Esophageal Brush Biopsy), AD-0005 (Medical Necessity Determinations), MM-1560 (Myoelectric Upper Extremity Orthosis), PY-1430 (NICU Level of Care), AD-1055 (Bilateral Procedures), AD-1175 (Claims Editing and Review), MM-1579 (DME Repairs), MM-1053 (Inhaled Nitric Oxide), MM-1473 (Non-Emergency Facility Transfers), AD-1143 (Obstetrical Care), MM-1457.V2 (Safety Beds), MM-1563 (Transcervical Radiofrequency Ablation), MM-1224 (Tumor Treatment Field Devices), AD-1049 (Molecular Diagnostic Testing), and PY-0007 (Preventive E/M Services). Document all changes, update billing software rules, encounter templates, and prior authorization workflows as needed. Communicate changes to clinical and billing staff. Failure to implement required changes may result in claim denials or compliance issues.