Ohio Medicaid — Ohio Medicaid (Next Generation Managed Care)
| Program name | Ohio Medicaid (Next Generation Managed Care) |
|---|---|
| Provider portal | https://managedcare.medicaid.ohio.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Ohio Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Ohio
The Blue Cross Blue Shield Association licensee in Ohio is Anthem Blue Cross and Blue Shield of Ohio (Elevance Health). See the Anthem (Elevance Health) payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Ohio
The dominant commercial insurers operating in Ohio, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Ohio
Ohio Medicaid (Next Generation Managed Care) contracts with the following managed-care organizations to administer Medicaid benefits in Ohio. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in Ohio
CGS Administrators, LLC is the Medicare A/B MAC for Ohio: Part A and Part B fee-for-service claims from Ohio go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to CGS Administrators, LLC as the DME MAC. Home health and hospice claims are processed by Palmetto GBA. In the current Medicare Coverage Database export, 215 active LCDs from these contractors apply to Ohio claims.
- CGS Administrators, LLC
A/B MAC (Part A and Part B claims); DME MAC (durable medical equipment and supplies)
- Palmetto GBA
Home health and hospice MAC
Selected active CGS Administrators, LLC policies for Ohio
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L36690 Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities
- L40140 MolDX: Molecular Testing for Solid Organ Allograft Rejection
- L38111 MolDX: Pigmented Lesion Assay
- L38303 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease
- L38992 Electroretinography (ERG)
- L34064 Panretinal (Scatter) Laser Photocoagulation
- L34062 Dialysis Access Maintenance
- L40224 Automated Detection and Quantification of Brain MRIs
- L33944 Blepharoplasty
- L33946 Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy
- L33950 Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
- L34008 Computerized Corneal Topography
Equipment, home health and hospice policies that apply in Ohio
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L34544 Hospice - Liver Disease
- L34547 Hospice - Neurological Conditions
- L34548 Hospice Cardiopulmonary Conditions
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Ohio billing
- Ohio Revised Code §3963.01+ (Ohio Surprise Billing Law, effective 2022)
- Ohio Administrative Code 5160-1-19 (Medicaid timely filing)
- Ohio Revised Code §3901.381 (prompt pay of health claims)
Provider licensing & enrollment in Ohio
Providers enroll with Ohio Medicaid via PNM (Provider Network Management) + OMES (Ohio Medicaid Enterprise System). All OH Medicaid MCOs use the centralized credentialing.
Major health systems headquartered in Ohio
| Health system | Headquarters |
|---|---|
| Cleveland Clinic | Cleveland, OH |
| University Hospitals | Cleveland, OH |
| OhioHealth | Columbus, OH |
| Mercy Health (Bon Secours Mercy Health) | Cincinnati, OH |
| ProMedica | Toledo, OH |
Frequently asked questions — Ohio billing
What is the Ohio Medicaid program called?
Ohio's Medicaid program is known as Ohio Medicaid (Next Generation Managed Care). Providers enroll and manage claims through the provider portal at https://managedcare.medicaid.ohio.gov.
What is the Ohio Medicaid timely filing limit?
Ohio Medicaid (Next Generation Managed Care) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Ohio's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Ohio Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Ohio Medicaid (Next Generation Managed Care). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Ohio?
The dominant commercial payers in Ohio include Anthem (Elevance Health), UnitedHealthcare, Aetna, Humana, along with the BCBS licensee Anthem Blue Cross and Blue Shield of Ohio (Elevance Health). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Ohio?
Ohio Medicaid (Next Generation Managed Care) contracts with 6 Medicaid MCOs tracked in the QuickIntell registry, including CareSource, Centene, Molina Healthcare, UnitedHealthcare, Anthem (Elevance Health). MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Ohio?
Ohio has 3 tracked state-level statutes that affect medical billing and RCM: Ohio Revised Code §3963.01+ (Ohio Surprise Billing Law, effective 2022); Ohio Administrative Code 5160-1-19 (Medicaid timely filing); Ohio Revised Code §3901.381 (prompt pay of health claims). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Ohio with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Ohio Medicaid (Next Generation Managed Care) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Ohio Medicaid and the member ID card before submission.