MedicaidPrior AuthHigh impact
Ambulatory Withdrawal Management - MEDICAID - OHIO (New)
Humana·OH · Psychiatry, Internal Medicine, Family Medicine·Medicaid
We identified it
Jun 30, 2026
Summary
Ohio Medicaid has implemented a new policy for ambulatory withdrawal management services that requires authorization based on ASAM (American Society of Addiction Medicine) treatment criteria. All substance use disorder treatment admissions, continued stays, discharges, and referrals must now align with ASAM level-of-care guidelines. Billing teams must verify authorization requirements and ensure clinical documentation supports ASAM criteria compliance before submitting claims.
Action Required
Immediately: (1) Billing team must contact Humana Ohio Medicaid to obtain specific authorization requirements, effective date, and required documentation for ambulatory withdrawal management claims. (2) Update claim submission protocols to require prior authorization verification for all substance use disorder (SUD) treatment services before billing. (3) Clinical staff must document ASAM level-of-care assessment and justification on all SUD treatment encounter notes. (4) Update billing system rules to flag all withdrawal management claims for authorization review. (5) Train providers on ASAM treatment criteria (admission, continued stay, discharge, and referral LOC requirements). Failure to obtain required authorization will result in claim denials. Contact the Humana provider services line at the referenced URL for complete policy details, effective date, and authorization submission procedures.