MedicaidDocumentationMedium impact
Substance Use Disorder Intensive Outpatient Program - MEDICAID - OHIO (New)
Humana·OH · Psychiatry, Internal Medicine, Family Medicine·Medicaid
We identified it
Jul 2, 2026
Summary
Humana Medicaid Ohio has established a new policy requiring substance use disorder intensive outpatient program (IOP) services to follow ASAM (American Society of Addiction Medicine) treatment criteria for all admission, continued stay, discharge, and level of care decisions. Billing teams must ensure providers document medical necessity according to ASAM standards and verify authorization requirements before service delivery.
Action Required
Immediately: Billing team and providers must review ASAM treatment criteria standards for substance use disorder services. Before submitting claims for SUD IOP services, verify with Humana Medicaid Ohio that prior authorization is obtained and that clinical documentation reflects ASAM level of care determination criteria. Update internal protocols to require providers to document ASAM LOC justification on all SUD IOP claims. Contact Humana through the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a569698) to confirm specific prior authorization codes and submission requirements. Failure to comply may result in claim denials for lack of medical necessity documentation.