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CareSourceMedicaid · Administrative · Medical Policy · OH · Gastroenterology, PsychiatryHigh impact

[Ohio] June 2026 Policy Updates

Act
by Jun 30, 2026
Effective date
Jul 1, 2026
Identified
Jun 6, 2026

Summary

CareSource Ohio Medicaid released consolidated policy updates effective July 1, 2026 (1 new policy) and August 1, 2026 (7 revised policies). Changes affect reimbursement policies for colonoscopy/sigmoidoscopy, DME modifiers, unlisted codes, and modifier usage; administrative policies for itemized billing, medical record documentation, and provider home visits; and a new medical policy for private duty nursing. Billing teams must review each policy on the CareSource website and implement changes by the effective dates to avoid claim denials.

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What to do

by Jun 30, 2026 · 7 steps
01Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Ohio Medicaid plan, and review all 8 updated/new policies (PY-1592, PY-0022, AD-0857, AD-0753, PY-1345, PY-1456, MM-1510, AD-1165, PY-1748).
02For each policy, identify specific billing code changes, documentation requirements, and modifier rules.
03Update billing software, encounter forms, and provider education materials accordingly.
04Effective July 1, 2026: Implement Community Behavioral Health Services Utilization Management changes (PY-1748).
05Effective August 1, 2026: Implement all remaining 7 policy changes.
06Notify clinical and administrative staff of new requirements.
07Document all changes in compliance files.
If missed: Failure to implement will result in claim denials and possible audit issues.

Original notice

[Ohio] June 2026 Policy Updates
caresource.com · Always check the source before changing claims.
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Related changes

See all CareSource changes →
[Ohio] October 2026 Policy UpdatesMediumEffective Nov 1, 2026 · Medical Policy[Ohio] September 2026 Policy UpdatesHighEffective Oct 1, 2026 · Medical Policy[Ohio] August 2026 Policy UpdatesHighEffective Oct 1, 2026 · Medical Policy[Ohio] July 2026 Policy UpdatesHighEffective Sep 1, 2026 · Medical PolicyBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesOH policy changesGastroenterologyPsychiatry

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