MedicaidAdministrativeHigh impact
[Ohio] September 2026 Policy Updates
CareSource·OH·Medical Policy
Effective date
Oct 1, 2026
We identified it
Sep 1, 2026
Summary
CareSource Ohio Medicaid is releasing 9 policy updates effective October 1 and November 1, 2026, spanning administrative, medical, and reimbursement categories. Key changes include a new prior authorization submission requirement (AD-1645), revisions to E/M visit billing when preventive and acute care occur same-day (PY-0007), updates to durable medical equipment repairs coverage (MM-1579), and changes to anesthesia care reimbursement (PY-1685). The billing team must review each policy in detail and implement system and workflow changes before the effective dates.
Action Required
By September 15, 2026: Billing team must access all 9 policies via CareSource.com > Providers > Tools & Resources > Provider Policies, review the full policy text for each, and compare against previous versions using archived policy webpages. By October 1, 2026: Implement changes for AD-1645 (new prior authorization submission procedures) in billing workflow and provider portals. By November 1, 2026: Update billing software and encounter forms to reflect all remaining 8 policy revisions, particularly: (1) PY-0007 modifier/billing rules for same-day preventive/acute E/M visits, (2) MM-1579 DME repair authorization thresholds, (3) PY-1685 monitored anesthesia care billing, (4) MM-1841 digital therapy device coverage criteria for amblyopia, (5) MM-1457 safety bed coverage requirements, (6) MM-1563 transcervical radiofrequency ablation authorization, (7) PY-1545 in-office lab testing billing, and (8) AD-1001 three-day window payment rules. Train billing staff and providers on changes. Without timely implementation, claims will be denied for non-compliance with new requirements.