Wiki CARESOURCE OHIO

[Lb6731@hotmail.com]

Happy New Year!

Having issues billing maternity care with Caresource Ohio. Sometimes they pay the global billing ( ex: 59425, 59409, 59430) and sometimes they will only pay the ante partum (59425 or 59426) and then deny the delivery and postpartum due to modifier needed. Any one else having these issues? Have not had much luck with customer service .

ANY suggestions will be greatly appreciated.

Thank you!

 

[sls314]

Happy New Year!

Having issues billing maternity care with Caresource Ohio. Sometimes they pay the global billing ( ex: 59425, 59409, 59430) and sometimes they will only pay the ante partum (59425 or 59426) and then deny the delivery and postpartum due to modifier needed. Any one else having these issues? Have not had much luck with customer service .

ANY suggestions will be greatly appreciated.

Thank you!

Which type of Caresource plan are you having trouble with?

Caresource Medicaid should follow Ohio Medicaid guidelines. Caresource Marketplace plans are a commercial product and follow Caresource's commercial guidelines.

(There's also Caresource Medicare in Ohio that follows Medicare guidelines, but I'm guessing you might encounter those less frequently for maternity care than the Medicaid and Marketplace products.)

I used to work with Ohio Caresource info pretty regularly - I might be able to direct you to some of their provider resources if I know which one of their products you're having an issue with.

 

[sls314]

If you're talking Medicaid, I would search MITS for the patient's eligibility throughout the pregnancy/delivery.

For example, if the patient changed Managed Medicaid plans, each plan would pay the portion of the care that occurred while the patient was eligible under them. You'd have to bill each plan separately.

If the patient was continuously covered by the same Managed Medicaid plan throughout the pregnancy, you should be able to bill globally.