MedicaidPrior AuthHigh impact
Community Behavioral Health Rehabilitative Services - MEDICAID - OHIO (New)
Humana·OH · Psychiatry, PM&R (Physical Medicine & Rehab)·Medicaid
We identified it
Jun 30, 2026
Summary
Humana Ohio Medicaid has issued new authorization requirements and clinical criteria for community behavioral health rehabilitative services, including community psychiatric supportive treatment, therapeutic behavioral services, and psychosocial rehabilitation. Billing teams must implement prior authorization procedures and ensure claims comply with the new coverage criteria to avoid denials.
Action Required
Immediately: Billing team must obtain and review the complete policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a56965e) to extract specific authorization requirements, clinical criteria, and any affected CPT/HCPCS codes for community psychiatric supportive treatment, therapeutic behavioral services, and psychosocial rehabilitation. Within 5 business days: Update billing system to flag claims for these services as requiring prior authorization before submission to Humana Ohio Medicaid. Notify behavioral health providers and clinical staff of new authorization procedures and documentation requirements. Add authorization request process to encounter forms and provider workflow. Failure to obtain prior authorization will result in claim denials and payment delays.