MedicaidPrior AuthHigh impact
[Ohio] Same‑Day Billing Limits for Per Diem Behavioral Health Services
CareSource·OH · Psychiatry·Claims & Billing
Effective date
Aug 24, 2026
We identified it
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.
Action Required
By August 24, 2026: Billing team must update billing software and claim submission protocols to enforce same-day service hour limitations. (1) Configure system to flag claims when H0015 or H0015TG is billed on same DOS as H2020 or H2012 to track combined group service hours. (2) Implement automated rule: if combined group services exceed one hour on same DOS, require prior authorization before claim submission. (3) Update 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. (4) Train billing staff to communicate with providers that both services require PA when same-day limits are exceeded. (5) Establish process to request prior authorizations from CareSource_OH_BH@CareSource.com or 1-800-488-0134 for claims exceeding one-hour limit. Claims submitted without required prior authorization for services exceeding same-day limits will be denied.