Behavioral Health Billing Solutions, LLC

05/28/2026

Ohio Medicaid announces New Prior Authorization Standard to Strengthen Oversight of Behavioral Health Services.

See the full update below.

https://content.govdelivery.com/accounts/OHMEDICAID/bulletins/4180036

News Release: Ohio Medicaid Announces New Prior Authorization Standards to Behavioral Health Services Ohio Department of Medicaid sent this bulletin at 05/28/2026 01:15 PM EDT View as a webpage / Share Governor Mike DeWine | Lt. Governor Jim Tressel | Director Scott Partika FOR IMMEDIATE RELEASE May...

05/26/2026

📢 REMINDER: ALL CLIENT MEETING 📢

We’re looking forward to connecting with all of our valued clients during our upcoming All Client Meeting at 11:00 am today! This is a great opportunity to receive important updates, stay informed, and ask questions.

🗓️ Don’t forget to register using the link below:
f1af17f4-6030-4e9a-a22e-01cfa99db590@a8314e99-b79d-4d01-a829-34a23ba448fb" rel="ugc" target="_blank">https://events.teams.microsoft.com/event/f1af17f4-6030-4e9a-a22e-01cfa99db590@a8314e99-b79d-4d01-a829-34a23ba448fb

We appreciate your partnership and look forward to seeing you there!

Microsoft Virtual Events Powered by Teams

05/13/2026

For Awareness: Ohio Governor Mike DeWine announced several new Medicaid fraud prevention initiatives that will impact providers across the state, with a specific focus on home healthcare, hospice providers and providers identified as "high risk".

Some of the announced changes include:

• A proposed six-month moratorium on new Medicaid home healthcare and hospice providers
• Increased provider reviews and payment suspensions for high-risk billing activity
• Expanded Electronic Visit Verification (EVV) requirements, including mandatory GPS verification
• Potential new requirements for live-in caregivers to utilize EVV

The initiatives are intended to strengthen oversight, enhance fraud prevention efforts, and improve Medicaid program integrity throughout Ohio.

Providers and organizations involved in Medicaid-funded services may want to monitor upcoming rule changes and implementation timelines closely.

05/12/2026

🔔 Important Update for Ohio Behavioral Health Providers

The Ohio Department of Medicaid has announced new utilization management policies effective July 1, 2026 to ensure appropriate care and prevent service layering.

Key changes:

✓ New authorization thresholds for behavioral health services

✓ "Pass-through" model—no prior auth needed initially; required after annual limits

✓ Applies to TBS, CPST, PSR, SUD services and more

✓ 7-day and 48-hour turnaround times for approvals


Important: Utilization prior to July 1 won't count toward new thresholds. Plans must notify providers 30 days before implementation.

Review the full details on 's website to understand how this impacts your billing practices.

Important Update: ODM Utilization Management Requirements Effective July 1st.

Important Update: ODM Utilization Management Requirements Effective July 1 Ohio Department of Medicaid sent this bulletin at 05/12/2026 12:55 PM EDT View as a webpage / Share Dear Providers- This notification is to inform community behavioral health providers of new utilization management policies a...

04/20/2026

𝐏𝐫𝐨𝐯𝐢𝐝𝐞𝐫… 𝐊𝐧𝐨𝐰 𝐭𝐡𝐞 𝐅𝐚𝐜𝐭𝐬 📚
Let’s talk about 𝟗𝟎𝟕𝟗𝟏 𝐝𝐞𝐧𝐢𝐚𝐥𝐬.

𝐓𝐡𝐞 𝐬𝐢𝐭𝐮𝐚𝐭𝐢𝐨𝐧 :
We received direction that CPT 90791 is limited to 𝘰𝘯𝘦 𝘱𝘦𝘳 𝘺𝘦𝘢𝘳, 𝘱𝘦𝘳 𝘱𝘢𝘵𝘪𝘦𝘯𝘵, leading to denials when a client was seen by more than one provider.

𝐖𝐡𝐚𝐭 𝐰𝐞 𝐰𝐞𝐫𝐞 𝐭𝐨𝐥𝐝 :
“Only one 90791 is allowed annually.”

𝐖𝐡𝐚𝐭 𝐭𝐡𝐞 𝐩𝐨𝐥𝐢𝐜𝐲 𝐚𝐜𝐭𝐮𝐚𝐥𝐥𝐲 𝐬𝐚𝐲𝐬 :
Per the Ohio Medicaid BH Provider Manual (pg. 22) and OAC 5160-8-05, the limitation applies 𝐩𝐞𝐫 𝐛𝐢𝐥𝐥𝐢𝐧𝐠 𝐚𝐠𝐞𝐧𝐜𝐲, not per patient across all providers.

𝐖𝐡𝐲 𝐭𝐡𝐢𝐬 𝐦𝐚𝐭𝐭𝐞𝐫𝐬 :
When patients transition between providers or agencies, a new diagnostic evaluation may be clinically appropriate and billable.
Incorrect application of this rule can result in:
• Unnecessary denials
• Delayed care access
• Lost reimbursement for providers

𝐓𝐚𝐤𝐞𝐚𝐰𝐚𝐲 :
Always verify how limitations are defined — "𝐩𝐞𝐫 𝐦𝐞𝐦𝐛𝐞𝐫" vs. "𝐩𝐞𝐫 𝐛𝐢𝐥𝐥𝐢𝐧𝐠 𝐚𝐠𝐞𝐧𝐜𝐲" makes a 𝐁𝐈𝐆 difference.
We escalated this for clarification and confirmed the policy supports billing per agency.

𝐒𝐭𝐚𝐲 𝐢𝐧𝐟𝐨𝐫𝐦𝐞𝐝. 𝐀𝐝𝐯𝐨𝐜𝐚𝐭𝐞 𝐰𝐢𝐭𝐡 𝐩𝐨𝐥𝐢𝐜𝐲. 💡

09/21/2025

Last day to register! Hope to see you there!

Unexplained denials don’t have to be a mystery.

Seeing CO-185, CO-299, or CO-B7—and not sure why? Join our breakout session to pinpoint root causes and rethink your data.

What: Breakout Session — live denial diagnostics + data deep-dives
Who: Our Director of Billing Services, Brittany Akin & Director of Provider Enrollment, Sara Brightman
When: September 25–26

Register now (closes Sunday, September 21, 2025): https://behavioralhealthbillingsolutio.regfox.com/bhbs-2025-annual-event

You’ll leave with a clear checklist, quick wins you can deploy Monday, and dashboards to spot issues sooner.

A huge thank you to our sponsors—Qualifacts, Humana, CareSource, AmeriHealth, Molina, and Buckeye. This wouldn’t be possible without you!

09/16/2025

Unexplained denials don’t have to be a mystery.

Seeing CO-185, CO-299, or CO-B7—and not sure why? Join our breakout session to pinpoint root causes and rethink your data.

What: Breakout Session — live denial diagnostics + data deep-dives
Who: Our Director of Billing Services, Brittany Akin & Director of Provider Enrollment, Sara Brightman
When: September 25–26

Register now (closes Sunday, September 21, 2025): https://behavioralhealthbillingsolutio.regfox.com/bhbs-2025-annual-event

You’ll leave with a clear checklist, quick wins you can deploy Monday, and dashboards to spot issues sooner.

A huge thank you to our sponsors—Qualifacts, Humana, CareSource, AmeriHealth, Molina, and Buckeye. This wouldn’t be possible without you!

09/16/2025

Denials don’t have to be a mystery.

Seeing CO-185, CO-299, or CO-B7—and not sure why? Join our breakout session to pinpoint root causes and rethink your data.

What: Breakout Session — live denial diagnostics + data deep-dives
Who: Our Director of Billing Services, Brittany Akin & Director of Provider Enrollment, Sara Brightman
When: September 25–26
Register now (closes Sunday, September 21, 2025): BHBS 2025 Annual Event https://behavioralhealthbillingsolutio.regfox.com/bhbs-2025-annual-event

You’ll leave with a clear checklist, quick wins you can deploy Monday, and dashboards to spot issues sooner.

A huge thank you to our sponsors—Qualifacts, Humana, CareSource, AmeriHealth, Molina, and Buckeye. This wouldn’t be possible without you!

09/08/2025

The BHBS 2025 Annual Seminar is just 17 days away! Thanks to our wonderful sponsors, this event is shaping up to be the best yet, with more expert speakers, breakout sessions, networking with peers, and incredible giveaways like this Pot-of-Gold basket with $400 worth of scratch-off tickets and a hand crocheted Leprechaun that is sure to provide extra luck!
Don’t miss out on this fun, informative event! Registration ends soon and our discounted hotel rate ends this Wednesday!

Register at https://behavioralhealthbillingsolutio.regfox.com/bhbs...

09/04/2025

We’re almost at capacity for our two-day event on Sept 25th and 26th at Quest Conference Center in Westerville.

The agenda has been updated! For both new and existing CareLogic agencies, we’ve added an end-of-day session showcasing new software features from Qualifacts. This session will highlight their Client Engagement tool (On Call) and their new AI tool. It’s going to be a highly informative session.

Register now: https://lnkd.in/e_wq57tu