MedicaidPrior AuthHigh impact
Ambulatory Withdrawal Management - MEDICAID - OHIO (New)
Humana·OH · Psychiatry, General Practice·Medicaid
Effective date
Jul 1, 2026
We identified it
Jun 30, 2026
Summary
Humana Healthy Horizons Ohio Medicaid establishes new coverage criteria for Ambulatory Withdrawal Management services effective 07/01/2026, requiring prior authorization based on ASAM (American Society of Addiction Medicine) levels of care. Billing teams must verify prior authorization requirements for all substance use disorder treatment services before claim submission to avoid denials and financial penalties.
Action Required
By 06/15/2026: (1) Billing team must update authorization submission timelines in practice management system—expedited requests require 2-day advance notice, standard requests require 7-day advance notice. (2) Front desk and billing staff must verify prior authorization status for ALL substance use disorder and community behavioral health center service requests BEFORE service delivery using the Ohio Medicaid Prior Authorization and Notification List accessible via Humana provider portal. (3) Providers must document medical necessity using ASAM level of care criteria (LOC 1: <9 hrs/week adults/<6 hrs/week adolescents; LOC 2: intensive outpatient/partial hospitalization including withdrawal management; LOC 3: 24-hour residential/inpatient) with all authorization requests. (4) Update patient intake forms and authorization checklists to capture ASAM LOC documentation. (5) Brief all clinical and billing staff that services provided without prior authorization may result in retrospective denial, financial penalties to the practice, and reduced member benefits. Contact provider services at 877-856-5707 or OHMCDUM@humana.com with specific code-level authorization requirements.