MedicaidAdministrativeMedium impact
[Ohio] Doula Services and Coordination of Benefits (COB)
CareSource·OH · OB-GYN·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jun 25, 2026
Summary
Effective July 1, 2026, doula services billed to Ohio Medicaid must now follow Coordination of Benefits (COB) rules, requiring providers to bill members' primary commercial insurance first before billing Medicaid. This change aligns with federal rules that mandate Medicaid pay only as secondary coverage when other insurances are available. The billing workflow for doula services changes, but member access to care remains unaffected.
Action Required
By June 30, 2026: Billing team and doula providers must update workflows to verify and bill members' primary (commercial) insurance for doula services BEFORE submitting claims to Medicaid. Update billing software, claim submission processes, and claim worksheets to reflect COB requirements for doula services. Train front desk staff to identify dual insurance coverage during patient intake. Reference CareSource Provider Manual pages 89-90 and FAQs for specific COB billing instructions. Starting July 1, 2026, claims submitted to Medicaid without evidence of primary insurance denial or explanation of benefits will be subject to denial or recoupment. Contact CareSource Provider Services at 1-800-488-0134 (Mon-Fri, 7 a.m. to 8 p.m. ET) for implementation guidance.