MedicaidDocumentationMedium impact
[Ohio] Update to High Dollar Claims
CareSource·OH, NV, WV·Provider Bulletin
Effective date
Jun 5, 2026
We identified it
Jun 6, 2026
Summary
CareSource now requires an Itemized Bill Cover Sheet for high-dollar claims (billed charges over $500,000), claims qualifying for itemized bill review, DRG claims, outpatient grouper pricing, and percent-of-charge contracts over $25,000. The cover sheet must be submitted via email or fax with the itemized bill documentation. Missing documentation may delay claim processing or result in denial.
Action Required
Effective immediately (June 5, 2026): Billing team must implement the following: (1) Obtain and customize the Itemized Bill Cover Sheet from CareSource.com Forms or Claims pages; (2) Update internal claim submission procedures to require completion of Section 1 of the cover sheet at time of claim submission for all high-dollar claims (billed charges over $500,000), DRG claims, outlier claims, outpatient grouper pricing claims, and percent-of-charge contracts over $25,000; (3) Establish a process to submit completed cover sheets and itemized bills via email (ClaimsItemizedBill@CareSource.com) or fax (1-937-396-3173 or toll-free 1-844-794-1579), noting the 12 MB file size limit and requirement to split large files into multiple submissions; (4) Train billing staff to type (not handwrite) the form for clarity and to include Section 2 notation when submitting files in multiple batches; (5) Apply this requirement to both new and corrected claim submissions. Failure to submit the required cover sheet and itemized documentation may result in claim processing delays or denials.