CareSource Ohio: Behavioral Health Recoupments Explained

At CareSource, we believe everyone deserves access to compassionate, high-quality behavioral health care, and we deeply value our partnership with the behavioral health providers in our network who make that care possible for our members.

We recently identified that CareSource had inadvertently overpaid some behavioral health providers. CareSource’s contractual reimbursement rates are tied to the rates a provider would receive directly from the state based on the Medicaid fee schedule. Per the Ohio Administrative Code (OAC), Rule 5160-8-05, which establishes payment levels based on service type, provider type and clinical setting, services rendered by a licensed or supervised practitioner are reimbursed at 85% of the established Medicaid fee schedule.

In alignment with our contracts, we are implementing the correct rates for all applicable behavioral health services in accordance with OAC Rule 5160-27-03, both retrospectively and for future claims.

This action does not represent a rate reduction. Rather, it reflects our responsibility to ensure claims are paid accurately. As a manager of public Medicaid funds, correcting overpayments helps ensure resources are used responsibly and remain available to support care for members—both today and for years to come.

Recoupments are a standard practice across healthcare. When a payment error is identified by a payer or provider, we follow an established process—just as we did in this instance—which includes notifying the provider and offering opportunities for review or dispute.

We understand that recoupments can cause concern for our provider partners who are crucial to caring for our members. We are actively working with them to offer clear and individualized guidance and flexible repayment options when needed. As always, we are committed to ensuring our members have high quality access to care and maintaining a sustainable behavioral health provider network for Ohioans.

Frequently Asked Questions

What is a recoupment?

A recoupment is a process to recover money that was paid in error.

Why do recoupments happen in healthcare?

Recoupments can occur for a variety of reasons including a payment did not align with Medicaid rules, approved billing codes, or agreed upon rates. When that happens, recoupment is the standard way to correct the error.

Why are recoupments especially important in Medicaid?

Medicaid is funded by taxpayers. Health insurers that administer Medicaid plans have a responsibility to manage these public funds carefully and in accordance with state and federal requirements. Recoupments help ensure Medicaid dollars are used appropriately and remain available to support care for people who rely on the program.

Is a recoupment the same as a rate cut?

No. Recoupments are not reductions to payment rates. They are corrections of past payments to align them with established Medicaid rules and contractual agreements.

How are providers notified?

When a recoupment is identified, insurers are required to notify providers and explain the reason for the adjustment. Providers are typically given options to review the determination, ask questions, dispute the finding if appropriate, and repay amounts over time. In this instance, Providers received a 30-day notice about the recoupments via mailed letters on April 17, which we also uploaded into their provider portal.

Do recoupments affect members or their care?

No. Recoupments are administrative payment corrections and do not change a member’s eligibility, benefits, or access to care.

Why is this part of responsible Medicaid stewardship?

Correcting payment errors helps protect public dollars, ensure fairness in reimbursement, and maintain the long-term sustainability of Medicaid. By addressing errors when they are identified, we help preserve the integrity of the program and support continued access to care for members across the community.