MedicaidAdministrativeMedium impact
[Ohio] Policy Updates January 2025
CareSource·OH · OB-GYN, Psychiatry, Sleep Medicine +1 more·Medical Policy
Effective date
Mar 1, 2025
We identified it
May 9, 2026
Summary
CareSource Ohio Medicaid is releasing 13 policy revisions effective March 1, 2025, affecting medical, administrative, and reimbursement policies across obstetrical care, behavioral health, sleep medicine, and specialty procedures. The billing team must review each specific policy to identify detailed changes, as this notice is a consolidation only and does not contain specific billing code or requirement modifications.
Action Required
By February 15, 2025: Billing team must access the full policy text for each of the 13 revised policies on CareSource.com (Providers > Tools & Resources > Provider Policies) to identify specific changes to billing requirements, prior authorization rules, documentation, or reimbursement rates. Prioritize policies affecting high-volume services: Obstetrical Care (AD-1143, PY-0939, PY-0004, AD-1017), Applied Behavior Analysis for Autism (MM-0028), and Readmission (AD-0972). Update billing software, encounter forms, and clinical workflows accordingly before March 1, 2025. Confirm with CareSource if prior authorization requirements changed for any policies. Claims submitted after March 1, 2025 not compliant with revised policies may be denied.