Medicaid.ohio.gov View all Health

Open Enrollment is here!

Details: Medicaid Behavioral Health Medicaid State Plan Media Center Subscribe to Medicaid News Medicaid Pharmacy Budget Ohio Department of Medicaid | 50 West Town Street, Suite 400, Columbus, Ohio 43215. Consumer Hotline: 800-324-8680 | Provider Hotline: 800-686-1516. Start of Statewide secondary footer. Powered by

› Verified 4 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/home Go Now

• Get more: Illinois medicaid eligibility verificationGo Now

Home Health Services

Details: Medicaid Home Health Services include home health nursing, home health aide services, and/or skilled therapies (physical therapy, occupational therapy, and speech-language pathology). To be considered a Medicaid home health service, these services must be provided to an eligible individual by a Medicare Certified Home Health Agency on a part

› Verified 8 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/families-and-individuals/citizen-programs-and-initiatives/home-health-services Go Now

• Get more: Department of ohio medicaidGo Now

Medicaid Programs

Details: MyCare Ohio is a system of managed care plans selected to coordinate physical, behavioral, and long-term care services for individuals over the age of 18 who are eligible for both Medicaid and Medicare. This includes individuals with disabilities, older adults, and individuals who receive behavioral health services. More Information.

› Verified 8 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/families-and-individuals/srvcs/medicaid-programs Go Now

• Get more: Ohio dept of medicaid providersGo Now

Home Health Services

Details: Home Health Services are Medicaid State Plan services provided on a part-time and intermittent basis to Medicaid consumers of any age. Home health services include home health nursing, home health aide, and skilled therapies (physical therapy, occupational therapy, and speech-language pathology). The only provider of home health services is a

› Verified 3 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/enrollment-and-support/provider-types/home-health-services/ Go Now

• Get more: Ohio department of medicaid providerGo Now

Schedules and Rates

Details: Outpatient Hospital Behavioral Health Services. The following information pertains to Behavioral Health Services provided by an outpatient hospital for dates of service on or after August 1, 2017: Outpatient Hospital Behavioral Health Codes and Rates (Revised 8/19/2021) Overview of Outpatient Hospital Behavioral Health Services (Revised 1/22/19)

› Verified 4 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/billing/fee-schedule-and-rates/schedules-and-rates Go Now

• Get more: Ohio medicaid provider websiteGo Now

OHIO Brief Child and Adolescent Needs and Strengths

Details: good clinical decision-making for intensive mental health service interventions and was the foundation of the CANS. The CSPI tool demonstrated its utility in informing decision-making for residential treatment (Lyons, Mintzer, Kisiel,

› Verified 8 days ago

› Url: https://managedcare.medicaid.ohio.gov/wps/wcm/connect/gov/7d7918d9-bc89-4397-b4d8-b59dcca9c90f/2021.06.11_REFERENCE+GUIDE_OH+CANS+Brief.pdf?MOD=AJPERES&CVID=nEqXNYO Go Now

• Get more: Ssp benefits ohio renew my benefitsGo Now

ACA Provider Compliance Programs: Getting Started Webinar

Details: Taitsman is a recognized expert in health care fraud and has conducted numerous training sessions to educate providers on compliance with laws and regulations to prevent fraud, waste, and abuse in the Medicare and Medicaid

› Verified Just Now

› Url: http://bh.medicaid.ohio.gov/Portals/0/Providers/MLN-Compliance-Webinar.pdf?ver=2017-03-06-172157-843 Go Now

• Get more: Illinois medicaid for providersGo Now

Population Health and Quality

Details: The Ohio Department of Medicaid takes a population health approach to improving the health and wellness of Ohio residents by grouping our Medicaid population into the following streams: Healthy Children and Adults, Women’s Health, Behavioral Health, and Chronic Conditions.

› Verified 2 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/about-us/qs/ Go Now

› Get more:  Health LifeGo Now

Managed Care Plan (MCP) Report Card

Details: Managed Care Plan (MCP) Report Card. Ohio Medicaid’s Managed Care Report Card is a quality performance tool that allows enrollees to evaluate and compare each plan based on performance in five critical health categories. Getting care: highlights the ease of obtaining needed care and how quickly care is received.

› Verified 6 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/managed-care/managed-care-plan-report-card Go Now

› Get more:  Health LifeGo Now

Companion Guides

Details: Medicaid Behavioral Health Medicaid State Plan Media Center Subscribe to Medicaid News Medicaid Pharmacy Budget Ohio Department of Medicaid | 50 West Town Street, Suite 400, Columbus, Ohio 43215. Consumer Hotline: 800-324-8680 | Provider Hotline: 800-686-1516. Start of Statewide secondary footer. Powered by

› Verified 5 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/billing/HIPAA-5010-implementation/companion-guides/ Go Now

› Get more:  Health LifeGo Now

Modifiers Recognized by Ohio Medicaid

Details: health care professional during the postoperative period 25 Significant, separately identifiable evaluation and management (E/M) service by the same physician or other qualified health care professional on the same day of the procedure or other service 26 Professional component of a procedure that has both a technical and a professional

› Verified 7 days ago

› Url: https://medicaid.ohio.gov/static/Providers/Billing/BillingInstructions/ModifiersODM.pdf Go Now

› Get more:  Health LifeGo Now

COVID-19 Vaccine Administration

Details: The Ohio Department of Medicaid (ODM) has been working closely with the Ohio Department of Health (ODH) to provide uniform information regarding the COVID-19 vaccine and its distribution to Ohioans. These guidelines are being provided to assist eligible enrolled providers with billing for administering the vaccine to Medicaid covered individuals.

› Verified 9 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/covid/covid-19-vaccine-administration-billing-guidelines-02092021 Go Now

› Get more:  Health LifeGo Now

Nursing Facilities

Details: PASRR is a federal requirement mandating that individuals seeking admission to a Medicaid-certified nursing facility be screened for indications of serious mental illness and/or developmental disability prior to admission, and then again on a systematic basis following a significant change in their condition.

› Verified 9 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/enrollment-and-support/provider-types/nursing-facilities/nursing-facilities Go Now

› Get more:  Health LifeGo Now

Aged, Blind, or Disabled (ABD) Medicaid

Details: Medicaid for Older Adults and People with Disabilities. Working Ohioans with disabilities may be interested in the Medicaid Buy-In for Workers with Disabilities program.. When applying for this type of Medicaid, proof of income, resources, age or disability, citizenship or non-citizen status, and other health insurance is required.

› Verified 7 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/families-and-individuals/citizen-programs-and-initiatives/aged-blind-disabled Go Now

› Get more:  Health LifeGo Now

THE OHIO DEPARTMENT OF MEDICAID OHIO MEDICAID …

Details: the ohio department of medicaid. ohio medicaid provider agreement . for managed care organization

› Verified 1 days ago

› Url: https://managedcare.medicaid.ohio.gov/wps/wcm/connect/gov/38e87337-f168-4a0f-a341-d3379b5dcf9c/MCO+Provider+Agreement_2021+06+29_final+for+signature.pdf?MOD=AJPERES&CVID=nGHQqH. Go Now

› Get more:  Health LifeGo Now

Ohio Medicaid selects Aetna Better Health of Ohio as the

Details: Aetna serves as the sole statewide coordinator of physical and behavioral health, dental care, and social services for approximately 28,000 children and youth in Kentucky’s child welfare and juvenile justice systems. Today, more than 225,000 children in 13 states receive high-intensity behavioral health programming and wraparound care

› Verified 8 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/news/press-release/04-05-2021-ohio-medicaid-selects-aetna-for-ohiorise-partner Go Now

› Get more:  Health LifeGo Now

Hospital Payment Policy

Details: Hospital Payment Policy. Inpatient acute care hospital services are reimbursed on a prospective basis using the All Patient Refined Diagnosis Related Group (APR-DRG) system. Outpatient acute care and ambulatory surgical center (ASC) services are reimbursed on a prospective basis using the Enhanced Ambulatory Patient Groups (EAPG) system.

› Verified 5 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/enrollment-and-support/provider-types/hospital-provider-information/hospital-payment-policy Go Now

› Get more:  Health LifeGo Now

Managed Care Plan Provider Telehealth Resource Guide

Details: Telehealth Health Plan Contact Information and Resources 15 Table of Contents 2. 3 Managed Care Plan Provider Telehealth Resource Guide I. Introduction to Telehealth What is Telehealth? Telehealth, as defined in emergency rule 5160-1-21* of the Ohio Administrative Code (OAC), is the direct delivery

› Verified 8 days ago

› Url: https://medicaid.ohio.gov/static/Providers/COVID19/Provider-Resource-Guide.pdf Go Now

› Get more:  Health LifeGo Now

FQHCs & RHCs Claims & Policy

Details: Ambulatory health care clinic as defined in OAC 5160‐13 FQHCs and RHCs Professional medical group Acupuncture Services: OAC 5160‐8‐51 Payment may be made for service that meets the following: Is medically necessary per OAC 5160‐1‐01

› Verified 1 days ago

› Url: https://medicaid.ohio.gov/static/Providers/Training/BasicBilling/FQHCs-Policy.pdf Go Now

› Get more:  Health LifeGo Now

Medicaid Eligibility Manual Table of Contents

Details: MEPL 97 (Medicaid: 2015 Federal Poverty Level Income Guidelines for MAGI-Based Medicaid) (3/12/15) MEMTL 97 (Medicaid: DDA Process Rule) (3/3/15) MEMTL 93 (Medicaid: Special Income Level) (2/11/15) MEMTL 91 (Medicaid: ABD Income Rules) (2/11/15) MEPL 96 (Medicaid: Ninety Day Reinstatement) (2/6/15) MEPL 95B (Correction to MPAP Resource Limit for an …

› Verified 2 days ago

› Url: https://medicaid.ohio.gov/static/About+Us/PoliciesGuidelines/eManuals/PreJuly2015/Medicaid-EligibilityManual.pdf Go Now

› Get more:  Health LifeGo Now

Pregnancy Risk Assessment

Details: The ODM 10207 can also be faxed to the MCP-contracted home health agency and specialty pharmacy as a home health referral and prescription. The web-based PRAF 2.0 offers the same benefits but automatically notifies the county, MCP and home health provider of the pregnancy and need for progesterone once it is submitted.

› Verified 6 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/special-programs-and-initiatives/praf/praf Go Now

› Get more:  Health LifeGo Now

Maternal and Infant Support

Details: ODM values health equity and is determined to address and eliminate health disparities. To successfully work towards this goal, ODM is committed to ensuring high-quality, person-centered care is delivered to our moms and babies to …

› Verified 3 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/families-and-individuals/citizen-programs-and-initiatives/maternal-and-infant-support/maternal-and-infant-support Go Now

› Get more:  Health LifeGo Now

Care Coordination and Assessments Rate Review

Details: Peer Home Health and Personal Care Aides $ 14.25 100.0% Subtotal Peer $ 14.25 100.0% Paraprofessional Community Health Workers $ 19.70 30.0% Paraprofessional Healthcare Support Workers, All Other $ 22.06 55.0% Paraprofessional Educational, Guidance, and Career Counselors and Advisors $ 27.56 15.0% Subtotal Paraprofessional $ 22.18 100.0%

› Verified 9 days ago

› Url: https://managedcare.medicaid.ohio.gov/wps/wcm/connect/gov/f69d6b4d-7175-4ea8-afee-54c8a8134787/OhioRISE_ICC+MCC+Rate+Discussion+Meeting_2021.05.25.pdf?MOD=AJPERES&CVID=nCB5KdG Go Now

› Get more:  Health LifeGo Now

HEALTHCHEK AND PREGNANCY RELATED SERVICES …

Details: ☐ A mental health exam ☐ A dental (tooth) exam ☐ A specialist exam: _____ Healthchek Treatment Services and Transportation to Health Care Appointments Healthchek covers tests and treatment services to treat problems or conditions found by an exam. Some tests and treatment services require prior approval.

› Verified 9 days ago

› Url: https://medicaid.ohio.gov/static/Resources/Publications/Forms/ODM03528fillx.pdf Go Now

› Get more:  Health LifeGo Now

MyCare Ohio Health Risk Assessment Submission Specifications

Details: MCOP’s health risk assessment data. Effective July 1, 2019, the MCOP must assess all newly enrolled members using the ODM standardized health risk assessment (HRA) tool within 90 calendar days of enrollment (i.e., 90 days includes the date of enrollment + 89 days). All other members must be assessed using the standardized HRA tool by July 1

› Verified 3 days ago

› Url: https://medicaid.ohio.gov/static/Providers/ManagedCare/MyCarePHMDSS/MCOP-Health-Risk-Assessment-Submission-Specifications-CY-2020.pdf Go Now

› Get more:  Health LifeGo Now

Telehealth Billing Guidelines

Details: - A mental health/substance abuse diagnosis code is still required to receive OPHBH reimbursement. - OPHBH teel heatlh servcies w llipay accordni g to the OPHBH fee scheduel . - Pel ase note: To the extent possbi el , pel ase incul de mo difier “GT” to indicate it was a telehealth service.

› Verified 8 days ago

› Url: https://medicaid.ohio.gov/static/Providers/COVID19/Telehealth/Telehealth-Billing-Guidelines-on-or-after-11-15-2020.pdf Go Now

› Get more:  Health LifeGo Now

Behavioral Health Services in Ohio Hospitals

Details: Behavioral Health (BH) Redesign was developed for community behavioral health agencies who employ a variety of practitioners; therefore most training and informational materials are directed toward the community agencies, as this is a big change for them

› Verified 6 days ago

› Url: https://medicaid.ohio.gov/static/Providers/FeeScheduleRates/OutpatientBehavioral/Outpatient-Hospital-BH-Services.pdf Go Now

› Get more:  Health LifeGo Now

Resources for Providers

Details: The next generation of Ohio Medicaid managed care is designed to improve wellness and health outcomes, support providers in better patient care, increase transparency and accountability, improve care for children and adults with complex behavioral needs, and emphasize a personalized care experience.

› Verified 3 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers Go Now

› Get more:  Health LifeGo Now

Become a Provider

Details: Medicaid Behavioral Health Medicaid State Plan Media Center Subscribe to Medicaid News Medicaid Pharmacy Budget Ohio Department of Medicaid | 50 West Town Street, Suite 400, Columbus, Ohio 43215. Consumer Hotline: 800-324-8680 | Provider Hotline: 800-686-1516. Start of Statewide secondary footer. Powered by

› Verified 4 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/managed-care/become-a-provider Go Now

› Get more:  Health LifeGo Now

COVID-19 Vaccine Administration and Treatment Billing

Details: The Ohio Department of Medicaid (ODM) has been working closely with the Ohio Department of Health (ODH) to provide uniform information regarding the COVID-19 vaccine and its distribution to Ohioans. These guidelines are being provided to assist eligible enrolled providers with billing for administering the vaccine to Medicaid covered individuals.

› Verified 8 days ago

› Url: https://medicaid.ohio.gov/static/Providers/COVID-19+Vaccine+administration_ODM+billing+guidelines_updated+08202021.pdf Go Now

› Get more:  Health LifeGo Now

FREQUENTLY ASKED QUESTIONS AND ANSWERS HOME …

Details: about home health face-to-face encounters is to be consistent with Medicare's guidance and answers to FAQs about face-to-face encounters mandated by the Patient Protection and Affordable Care Act (PPACA). There is a link on the Centers for …

› Verified 2 days ago

› Url: https://medicaid.ohio.gov/static/Providers/ProviderTypes/HHS/FAQfdeb.pdf Go Now

› Get more:  Health LifeGo Now

Transportation, Non-Emergency (NET) Table of Contents

Details: (i) Federally qualified health centers (FQHCs), as specified in Chapter 5101:3-28 of the Administrative Code; (ii) Managed care plans (MCPs), as specified in Chapter 5101:3-26 of the Administrative Code; or (iii) Pregnancy-related services, as specified in rule 5101:1-38-06 of the Administrative Code.

› Verified 4 days ago

› Url: https://medicaid.ohio.gov/static/About+Us/PoliciesGuidelines/eManuals/PreJuly2015/Transportation-Non-emergency.pdf Go Now

› Get more:  Health LifeGo Now

COVID-19 Vaccine Administration Billing Guidelines

Details: » Rural Health Clinic (05) *These instructions do not apply to Medicare crossover claims. Provider-submitted crossover claims should be submitted with the information provided by Medicare on the explanation of medical benefits (EOMB). 8 …

› Verified 6 days ago

› Url: https://medicaid.ohio.gov/static/Providers/COVID19/COVID-19+Vaccine+administration_ODM+billing+guidelines_updated+06252021.pdf Go Now

› Get more:  Health LifeGo Now

OhioRISE (Resilience through Integrated Systems and

Details: Behavioral Health Respite: provide short-term, temporary relief to the primary caregiver(s) of an OhioRISE plan enrolled youth, in order to support and preserve the primary caregiving relationship. These services will be provided through a collaborative delivery system, as illustrated in the image below.

› Verified Just Now

› Url: https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/ohiorise/ Go Now

› Get more:  Health LifeGo Now

Home Health/Private Duty Nursing

Details: home health nursing, home health nursing aide, physical therapy, occupational therapy, and speech-language pathology. Home health service providers bill and are reimbursed on the basis of HCPCS codes. The . reimbursement rate for each of these codes has been reduced by three percent, resulting in an annual

› Verified 5 days ago

› Url: https://medicaid.ohio.gov/static/About+Us/PoliciesGuidelines/eManuals/PreJuly2015/HomeHealth-PrivateDutyNursing.pdf Go Now

› Get more:  Health LifeGo Now

2021 Introduction to Change Healthcare Vol. 16. Change

Details: health care utilization, and direct costs). Preventive therapy is indicated when migraine attacks interfere with daily functioning and are frequent or debilitating. Antihypertensives such as propranolol or metoprolol, antidepressants such as amitriptyline or venlafaxine, and anticonvulsant agents such as

› Verified 1 days ago

› Url: https://pharmacy.medicaid.ohio.gov/sites/default/files/2021_Vol_16_DUR_Digest.pdf Go Now

› Get more:  Health LifeGo Now

Managed Care for Providers

Details: behavioral health, and; all other clean claim types. For MyCare Ohio plans, the following claim types will be separately measured against the 30 and 90 calendar day prompt pay standards: nursing facility/hospice room and board; behavioral health; waiver services, and; all …

› Verified 5 days ago

› Url: https://medicaid.ohio.gov/wps/portal/gov/medicaid/resources-for-providers/managed-care/support/ Go Now

› Get more:  Health LifeGo Now

Ohio Comprehensive Primary Care

Details: Behavioral Health Integration 20 Clinical Quality Metrics. Total Cost of Care. Payment Streams. Shared Savings. Based on self-improvement & performance All Core Requirements Required to Receive. relative to peers . 4 Efficiency Metrics • ED visits • Inpatient admissions for ambulatory sensitive conditions • Behavioral health related

› Verified 8 days ago

› Url: https://medicaid.ohio.gov/static/Providers/PaymentInnovation/CPC/CPC-Program-Updates.pdf Go Now

› Get more:  Health LifeGo Now

2016-08-31 MCP Pharmacy Reference Guide

Details: Buckeye Health Plan CareSource Molina Healthcare of Ohio United Healthcare Community Plan of Ohio Briova Specialty Pharmacy 1-855-427-4682 CVS/Caremark Specialty Pharmacy 1-800-237-2767 Accredo Specialty 1-800-778-1403 Fax: CVS Caremark Specialty Pharmacy 1-800-237-2767 Medicare/Medicaid

› Verified 9 days ago

› Url: https://pharmacy.medicaid.ohio.gov/sites/default/files/2018-04-30-mcp-and-mycare-pharmacy-reference-guide.pdf Go Now

› Get more:  Health LifeGo Now

Provider Component Data Report (NF): Effective Date 07/01

Details: 0076197 The Lakes Of Monclova Health Campus Lucas 2-S 108.23 66.58 10.79 3.08 16.44 -1.79 0.00 21.78 0.00 225.11 5.03 0076444 Jackson Ridge Rehabilitation And Care Center Stark 2-S 120.40 66.58 10.79 2.19 16.44 -1.79 0.00 15.84 0.00 230.45 5.38

› Verified 2 days ago

› Url: https://medicaid.ohio.gov/static/Providers/ProviderTypes/LongTermCare/NursingFacility/NFR-20210701.pdf Go Now

› Get more:  Health LifeGo Now

Related topics