Updates & Announcements

We strive to make partnering with us simple. We’re aware things may change in the way we do business with you and want to communicate these changes to you in an efficient manner.

Claims Payment Systemic Errors (CSPE) Report

A CPSE is defined as the CareSource MyCare Ohio Plan’s (MCOP’s) claim’s adjudication incorrectly underpaying, overpaying, or denying claims that impact five or more providers. A report containing all active CPSEs is updated monthly.

The CPSE (coming soon) is updated on a monthly basis. Please review this log for updates on CPSE status, target dates for reprocessing and resolutions.

General Updates

2026Date
Navigate Pharmacy Policy Updates June 202606/12/2026
Navigate June 2026 Policy Updates – Revision 06/10/2026
Navigate OAC Rule 5160-1-17.9 Ordering, Referring and Prescribing Providers06/10/2026
Navigate Update to High Dollar Claims06/05/2026
Navigate Requirements to Enroll Providers in PNM06/03/2026
Navigate Evolent Healthcare Advanced Radiology Policy Revision Notice06/01/2026
Navigate Evolent Healthcare Advanced Radiology06/01/2026
Navigate June 2026 Policy Updates06/01/2026
Navigate Behavioral Health Service Frequency Guidelines05/27/2026
Navigate Access and Availability | After Hours Standard Change05/22/2026
Navigate Pharmacy Policy Updates May 202605/01/2026
Navigate May 2026 Policy Updates05/01/2026
Navigate Phase 3 Next Generation MyCare Rollout04/28/2026
Navigate Remittance Advice Service Date Correction – Revision 04/23/2026
Navigate MyCare Next Gen RationalMed Network Notification04/23/2026
Navigate Remittance Advice Service Date Correction04/17/2026
Navigate EVV Claims Processing04/14/2026
Navigate Patient Liability NotificationUPDATE04/03/2026
Navigate Evaluation and Management Coding Review04/03/2026
Navigate EDI Claims Intake Issue04/02/2026
Navigate Cultural Competency04/02/2026
Navigate Requirements for Including National Drug Code04/02/2026
Navigate Avalon Policy Updates Q3/Q4 202504/02/2026
Navigate Pharmacy Policy Updates April 202604/01/2026
Navigate 2026 Quality Enhancer Program04/01/2026
Navigate April 2026 Policy Updates04/01/2026
Navigate Ohio Department of Medicaid Next Generation MyCare Webinars03/13/2026
Navigate Delta Dental Policy Updates March 202603/01/2026
Navigate TurningPoint Annual Policies March 202603/01/2026
Navigate Evolent Annual Guideline Updates March 202603/01/2026
Navigate Policy Updates - March 202603/01/2026
Navigate EVV Claims Processing02/18/2026
Navigate Next Generation MyCare Level of Care Guidance-Nursing Facilities02/09/2026
Navigate Prior Authorization Requirement Update02/03/2026
Navigate Policy Updates - February 202602/01/2026
Navigate Evolent Policy Updates February 202602/01/2026
Navigate Prepay Auditing Update01/29/2026
Navigate Next Generation MyCare - EDI Transactions 01/23/2026
Navigate Notice to Home Health Agencies Regarding License Renewal Grace Period01/21/2026
Navigate 2026 CareSource Live Provider Education and Training Series01/14/2026
Navigate MyCare Waiver Claim Submissions01/10/2026
Navigate Provider Connections: Next Generation Waiver Providers01/09/2026
Navigate Provider Connections: Navigating Next Generation MyCare Claims Success: Join Our Office Hours for Claim Guidance01/05/2026
Navigate Policy Updates - January 202601/01/2026
Navigate 2026 Delta Dental Policies01/01/2026
Navigate Important Information on Provider Types, Specialties and Billing Codes01/01/2026
Navigate Refund Check Lock Box Address01/01/2026
Navigate Optum Process Frequently Asked Questions01/01/2026
Navigate High Dollar Claims01/01/2026
2025Date
Navigate Next Generation MyCare Ohio Eligibility Confirmation Guidance12/30/2025
Navigate Transition of DentaQuest and SkyGen to Delta Dental – UPDATE12/29/2025
Navigate 2026 CareSource Connections Schedule12/16/2025
Navigate Next Generation MyCare Ohio Waiver Provider December Orientation and Office Hours12/04/2025
Navigate Cardiac and Musculoskeletal Surgical Quality and Safety Management Program in Partnership with TurningPoint12/02/2025
Navigate Transition of DentaQuest and SkyGen to Delta Dental12/01/2025
Navigate TurningPoint Policies12/01/2025
Navigate Evolent Policies12/01/2025
Navigate Avalon Policies - Q212/01/2025
Navigate Avalon Policies12/01/2025
Navigate Telehealth and Remote Patient Monitoring 12/01/2025
Navigate CareSource and Evolent Prior Authorization Program Partnership12/01/2025
Navigate Updates to Assist with Avalon Laboratory Benefit Management Transition12/01/2025
Navigate Next Generation MyCare Ohio Waiver Providers Orientation and Office Hours11/14/2025
Navigate Changes to Home Modification Partnerships – UPDATE11/12/2025
Navigate Transition to EyeMed for Routine Vision Services11/10/2025
Navigate Serious Illness Support: Partner with Tuesday Health11/03/2025
Navigate Changes to Home Modification Partnerships – This notification has been revised. See notification dated 11/12/2025.11/03/2025
Navigate ODM Next Generation MyCare Program Webinar10/29/2025
Navigate Provider Connections: Navigating CareSource MyCare Ohio Claims Success: Join Our Office Hours for Claim Guidance10/21/2025
Navigate Next Generation MyCare Ohio Program10/15/2025
Navigate New Claim Condition Code Requirements10/15/2025