Behavioral Health Billing Solutions, LLC

10/09/2026

🚨 OHIO MEDICAID PROVIDER ALERT

Effective October 6, 2026, the Ohio Department of Medicaid (ODM) has implemented a new requirement related to Medicaid provider enrollment and revalidation.In accordance with ORC 5164.303, providers seeking to enroll or revalidate their enrollment with Ohio Medicaid are now required to review, sign, and submit the ODM 10255 – Fraud Penalties Disclaimer.

📌 What providers need to know:

✔️ Individual practitioners must sign their own ODM 10255.
✔️ For facilities, groups, and organizations, the form must be signed by an individual disclosed on the Owner Information page in PNM.
✔️ The completed form must be uploaded to the Agreements page of the applicable PNM application.⚠️ ODM has advised that failure to comply with this requirement may result in denial or termination of the Medicaid Provider Agreement.
🔗 ODM 10255 – Fraud Penalties

Disclaimer:https://lnkd.in/gfeP_6ht ORC 5164.303:https://lnkd.in/gcEtusfP

BHBS clients: Our Provider Enrollment team is incorporating this requirement into our credentialing and enrollment processes and will work with your organization to obtain the appropriate documentation when needed.Stay informed. Stay prepared. Stay compliant.

10/08/2026

BHBS has been reviewing the overall impact from the OMES outage for claims sent to OMES 09/18/2026 - 09/29/2026 where MCE claims could not be sent by the Fiscal Administrator. We have some problematic findings that we have reported to our Clearing House, Etactics.

Amerihealth MCD - Claims were accepted 09/30 or 10/01 but no further processing
Molina MCD - Claims were accepted 09/30 or 10/01 but no further processing.
United Healthcare MCD - All claims sent during that time period are denying for N799 Submitted identifier must be an individual identifier, not group identifier. We have reported that and they are investigating.
All others including MyCare, OhioRISE, and FFS MCD seem to be processing fine.

I would recommend going into your clearing house and checking the status of any claim files sent during the outage time period.

10/08/2026

Update from the Fiscal Administrator.

BHBS sent a number of 276 claims status files on the 6th to check on payment status from the MCE file issue in September. We have not received a single response.

10/07/2026

IMPORTANT!!

ODM updated rule ODM: BIA: ERF236150: Behavioral Health Policy FYRR Comment Period 10/5/26 to 10/12/26. Send comments to [email protected]; [email protected].

https://lnkd.in/dm3KEtYU

One important piece we've pulled out of it so far is below.

(2) Mental health day treatment hourly and per diem services are(a) Provided by a licensed practitioner or unlicensed mental health practitioner as defined in paragraph (A)(2) of rule 5160-27-08 of the Administrative Code.
(i) Effective July 1, 2027, mental health day treatment hourly and per diem group counseling services can only be provided by a licensed practitioner as described in rule 5160-27-01 of the Administrative Code.
(b) Maintain a staff to recipient ratio that does not exceed 1:12.

09/28/2026

Good afternoon,

BHBS just received the update below from the Fiscal Administrator.

Summary: They completed processing of the MCE files. Due to the volume of files processed, they may be delays in 277 and 835 delivery.

09/28/2026

We asked for an update this morning. Response is below.

REMINDER: This will impact payment processing. CLAIMS HAVE NOT BEEN SENT TO THE MCE's SINCE 09/18/2026.

INC: INC11945657

Short description: Claims processing

Comments:

2026-09-28 09:18:39 EDT - Additional comments

Thank you for reaching out to the OMES EDI Support for your query. Please find the information to your query below,

Our technical team is still working on your inquiry and will provide an update once there is more information to share.

Thank you and really appreciate your patience.

Regards,

OMES EDI Support Team

[email protected]

2026-09-28 09:13:10 EDT - Guest UserAdditional comments

reply from: [email protected]

We would like to get an update on the claims processing issue posted September 22nd.

Thank you,

Teresa Heim

2026-09-28 09:18:39 EDT - Mitesh ChampaneriAdditional comments

Thank you for reaching out to the OMES EDI Support for your query. Please find the information to your query below,

Our technical team is still working on your inquiry and will provide an update once there is more information to share.

Thank you and really appreciate your patience.

Regards,

OMES EDI Support Team

[email protected]

2026-09-28 09:13:10 EDT - Guest UserAdditional comments

reply from: [email protected]

We would like to get an update on the claims processing issue posted September 22nd.

Thank you,

Teresa Heim

Important Update from ODM on Claim Processing. We will update as the status changes.

09/26/2026

We did ask for an update yesterday. There is no ETA and they will provide updates every two days.

Reminder: This will impact payment status since claims are not being sent to the MCE’s.

Important Update from ODM on Claim Processing. We will update as the status changes.

09/24/2026

We just sent the email below to our client base.

Good afternoon,

We discovered this morning that ODM had put out a notice on their website stating an ONGOING internal issue in their electronic data system that is affecting claim files. As a result, the MCE's have not received claim files since September 19th, 2026. There is no ETA that we are aware of. We will keep monitoring to ensure we know when the problem is resolved.

THIS WILL IMPACT YOUR PAYMENT STATUS, so please be aware and prepared.

The notice we found is below. We will let you know as soon as we receive an updated status.

Important Update from ODM on Claim Processing. We will update as the status changes.

09/24/2026

Important Update from ODM on Claim Processing. We will update as the status changes.

09/16/2026

Individual Revalidations are now in process. See notification below.

Dear Provider,

Ohio Medicaid is conducting a federally directed, statewide revalidation of all Medicaid providers to support and strengthen program integrity efforts. Any provider whose last revalidation was before June 1, 2025 must complete a new revalidation as part of this federally directed effort.

Between September 9 and September 14, Ohio Medicaid will update revalidation dates for the majority of the provider community. Beginning September 15, the updated revalidation dates displayed in the Provider Network Management (PNM) system will be complete.

Please watch for your official notice, which will be uploaded to your PNM correspondence folder at least 90 days prior to your revalidation due date. This notice will indicate that you may begin the revalidation process. Additional instructions will be provided to help you access and complete the revalidation application in PNM.

Ohio Medicaid hosts a “revalidations due” spreadsheet on the public-facing Ohio Medicaid website. This spreadsheet, which will be available beginning September 15, 2026, is a resource that allows stakeholders to view upcoming revalidation dates for the provider community.

Revalidations due spreadsheet link - https://lnkd.in/dJ6QwGFN

Providers who currently do not have an NPI will not be included on the “revalidations due” spreadsheet. Although these providers will not appear on the spreadsheet, they are still responsible for adhering to the updated revalidation date assigned to their Medicaid account and all will receive an official notice at least 90 days before the revalidation date, as noted above.

Thank you for your continued participation in the Ohio Medicaid program.