MedicaidPrior AuthMedium impact
5160-1-31 - Prior authorization. (New/Final File)
Ohio Medicaid·OH·Prior Authorization
Effective date
Jun 30, 2024
We identified it
Jun 20, 2026
Summary
Ohio Medicaid has implemented a new prior authorization rule (5160-1-31) effective June 30, 2024, that applies to all Medicaid services except those provided through Medicaid managed care plans (MCPs). This policy replaced the previous version and establishes updated prior authorization requirements for Ohio Medicaid fee-for-service claims.
Action Required
Billing team must verify which Ohio Medicaid patients are enrolled in managed care plans versus fee-for-service Medicaid. For fee-for-service Medicaid patients, ensure all required prior authorizations are obtained according to the new rule 5160-1-31. Contact Ohio Department of Medicaid at 614-752-3877 for specific prior authorization requirements under the updated policy.