MedicaidAdministrativeMedium impact
[Ohio] Policy Updates August 2025
CareSource·OH·Medical Policy
Effective date
Oct 1, 2025
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid released three policy revisions effective October 1, 2025: Laboratory Testing in Office Setting (PY-1545), Private Duty Nursing (MM-1510), and Readmission–Behavioral Health (AD-1018). This notification announces policy updates without providing specific details; the billing team must access the full policy text via CareSource.com to identify required workflow changes.
Action Required
By September 30, 2025: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Ohio Medicaid plans, and review the full text of all three revised policies (PY-1545, MM-1510, AD-1018). Document any changes to billing codes, prior authorization requirements, documentation standards, or reimbursement methodology. Update billing software, encounter forms, and provider workflows accordingly. Implementation must be complete before October 1, 2025 effective date to prevent claim denials or processing delays.