Ohio Next Generation MyCare Nursing Facility Providers: Claims payment will not be denied solely due to the absence of a Level of Care (LOC) determination. Providers should submit all claims for processing. If you have any questions, please reach out to our Post Acute Provider Relations team for assistance. PostAcuteProviderRelations-OH@caresource.com.
The National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2016 required the development of a system where non-Department of Defense (DoD) (TRICARE) mental health care providers may receive a mental health Provider Readiness Designation. These mental health providers are specifically highlighted in the TRICARE directory as having earned this designation. Read more.
You’re Invited to Provider Connections!
The Health Partner Engagement team is excited to announce the launch of Provider Connections, a monthly forum created for provider office staff. For more information, please click here. We look forward to seeing you there!
Ohio Next Generation MyCare Waiver Providers who encounter any issues with claims submissions are encouraged to reach out for assistance.
– Provider Call Center is available at 1-800-488-0134 Monday through Friday from 8 a.m. – 8 p.m.
– Dedicated HCBS Provider Relations Representatives are available at CareSourceOHLTSSHCBSSupport@caresource.com.
– Office Hours are available. Please complete the Office Hours Registration Form and you will be invited to join our daily office hour sessions.
Claim submissions through the OMES one front door are based on the date of submission.
– Any claims submitted on January 1, 2026, or after should be submitted to the OMES one front door, even if the date of service was before January 1, 2026.
– Providers that have claims rejected due to this should resubmit claims using the correct payer ID for CareSource. 0021599
– Refer to the Companion Guides for more information.
Attention Ohio Next Generation MyCare Providers: Claim submissions through the OMES one front door are based on the date of submission.
Any claims submitted on January 1, 2026, or after should be submitted to the OMES one front door, even if the date of service was before January 1, 2026.
Providers who have claims rejected due to this issue should resubmit claims using the correct payer ID for CareSource: 0021599. Refer to the Companion Guides for more information.
Ohio Next Generation MyCare Waiver Providers who encounter any issues with claims submissions are encouraged to reach out for assistance.
– Provider Call Center is available at 1-800-488-0134 Monday through Friday from 8 a.m. – 8 p.m.
– Dedicated HCBS Provider Relations Representatives are available at CareSourceOHLTSSHCBSSupport@caresource.com.
– Office Hours are available. Please complete the Office Hours Registration Form and you will be invited to join our daily office hour sessions.
Effective January 1, 2026, CareSource will no longer offer Marketplace coverage in Kentucky.
Members’ plans will remain active through December 31, 2025, with paid premiums After that date, you will still be able to manage members’ claims and access historical records. Claims for services rendered to members through December 31, 2025, must be submitted by December 31, 2026. Claim disputes must be submitted within two years after the claim is processed.
Effective January 1, 2026, CareSource North Carolina Co. will no longer offer Marketplace coverage in North Carolina.
Members’ plans will remain active through December 31, 2025, with paid premiums. After that date, you will still be able to manage members’ claims and access historical records. Claims for services rendered to members through December 31, 2025, must be submitted by December 31, 2026. Claim disputes must be submitted within two years after the claim is processed.
Important Changes Coming as Part of the Next Generation MyCare Program
Starting January 1, 2026, CareSource will begin offering a combined Medicare and Medicaid plan, CareSource® MyCare Ohio (HMO D-SNP). Rolling out in a phased approach with statewide coverage by August 1, 2026. Learn more at CareSource.com/MyCare2026.
Important Update: Only Provider Type 60 Medicare Certified Agencies can bill for Home Health G-codes (ODM Rule 5160-12-05).
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