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Ohio MedicaidMedicaid · Administrative · Program Integrity · OHHigh impact

5160-1-17.51 - Suspension of medicaid provider claims payments during a pending audit or investigation. (New/Original File)

Effective date
Nov 16, 2026
Identified
Oct 17, 2026

Summary

Ohio Department of Medicaid has established a new rule (5160-1-17.51) effective 2026-11-16 that authorizes suspension of Medicaid provider claims payments during pending audits or investigations. This replaces an emergency rule that expired 2026-10-01. Billing teams must understand that claims may be held without payment during audit/investigation periods.

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What to do

Action · 3 steps
01By 2026-11-16: Billing team and compliance staff should review the full text of rule 5160-1-17.51 (available via the Register of Ohio) to understand the specific conditions, notice requirements, and procedures for claims suspension during Medicaid audits or investigations.
02Providers should establish internal protocols to identify when claims may be suspended and communicate with patients and payers accordingly.
03Note: An emergency version of this rule was already in effect from 2026-06-02 through 2026-10-01; verify whether your practice was already subject to claims suspension authority under that emergency rule and confirm current applicability of the permanent rule.

Original notice

5160-1-17.51 - Suspension of medicaid provider claims payments during a pending audit or investigation. (New/Original File)
registerofohio.state.oh.us · Always check the source before changing claims.
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Related changes

See all Ohio Medicaid changes →
5160-1-17.5 - Suspension of medicaid provider agreements. (New/Original File)MediumEffective Nov 16, 2026 · Medical Policy5160-1-17.5 - Suspension of medicaid provider agreements. (Rescind/Original File)MediumEffective Nov 16, 2026 · Medical PolicyBrowse every Ohio Medicaid change in the policy list

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