MedicaidAdministrativeMedium impact
[Ohio] May 2025 Policy Updates
CareSource·OH·Medical Policy
Effective date
Jun 1, 2025
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid is releasing 16 policy updates effective June 1 and July 1, 2025, affecting medical coverage criteria, reimbursement rates, and administrative procedures. Two new policies (Doula Services PY-1591 and Diagnostic Colonoscopy PY-1592) are being added, while 14 existing policies are being revised. Billing teams must review each policy individually to identify specific coverage, coding, and prior authorization changes.
Action Required
By May 31, 2025: Billing team must access each of the 16 policies listed on CareSource.com (Providers > Tools & Resources > Provider Policies) to identify specific billing code changes, prior authorization requirements, and coverage updates. For policies effective June 1, 2025 (Diagnostic Colonoscopy PY-1592 and General Anesthesia/Dental PY-1593), implement changes immediately in billing software and provider communication. For July 1, 2025 policies (14 total), prepare system updates, modifier rules, and prior authorization workflows by June 30, 2025. Update encounter forms and billing templates to reflect new documentation requirements. Communicate changes to all clinical staff and providers. Failure to implement required prior authorizations may result in claim denials.