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CareSourceMedicaid · Prior Auth · Claims & Billing · OH · PsychiatryHigh impact

[Ohio] Same‑Day Billing Limits for Per Diem Behavioral Health Services

Act
by Aug 24, 2026
Effective date
Aug 24, 2026
Identified
Jul 28, 2026

Summary

Effective August 24, 2026, CareSource will enforce same-day billing limits for behavioral health services in Ohio. When SUD IOP/PHP group counseling (H0015, H0015TG) is billed on the same day as TBS group services (H2020, H2012), providers may bill up to one hour of additional group services without prior authorization. Any additional group services exceeding one hour on the same date of service require prior authorization, and both services require PA when limits are exceeded.

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What to do

by Aug 24, 2026 · 7 steps
01Billing team must update billing software and claim submission protocols to enforce same-day service hour limitations.
02Configure system to flag claims when H0015 or H0015TG is billed on same DOS as H2020 or H2012 to track combined group service hours.
03Implement automated rule: if combined group services exceed one hour on same DOS, require prior authorization before claim submission.
04Update provider encounter forms and billing guidelines to clearly document: IOP/PHP group counseling + up to one hour of separate group service allowed same-day without PA; additional hours require PA.
05Train billing staff to communicate with providers that both services require PA when same-day limits are exceeded.
06Establish process to request prior authorizations from CareSource_OH_BH@CareSource.com or 1-800-488-0134 for claims exceeding one-hour limit.
07Claims submitted without required prior authorization for services exceeding same-day limits will be denied.

Codes mentioned

H0015H0015TGH2020H2012

Original notice

[Ohio] Same‑Day Billing Limits for Per Diem Behavioral Health Services
caresource.com · Always check the source before changing claims.
View original ↗

Related changes

See all CareSource changes →
[Ohio] Community Behavioral Health BillingHighEffective Sep 4, 2025 · Claims & Billing[Ohio] Behavioral Health Service Frequency GuidelinesHighEffective Jul 1, 2026 · Specialty Services[Georgia] CareSource Policy and Prior Authorization changesHighEffective Jan 1, 2026 · Medical PolicyBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesOH policy changesPsychiatryCode H0015Code H0015TGCode H2020Code H2012

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