Our claims are being denied as non-participating. Can you fix that?

Usually yes, and it is normally an enrollment gap rather than a billing error. We confirm participation per provider per plan and work the enrollment, then rebill what is still inside the filing window.

Do you handle OhioRISE?

Yes, as a distinct program with its own rules rather than as ordinary Medicaid managed care.

Do you bill behavioral health in Ohio?

Yes. It is one of the specialties where using generic billing rules causes the most avoidable denials, so it is worked with its own authorization and documentation expectations.

Can you take just our old A/R?

Yes, as a fixed-scope project worked oldest bucket first, with a contingency option, while you keep current billing where it is.

Ohio

Medical billing for Ohio practices

Ohio restructured its Medicaid managed care program, and practices that never revisited their enrollment afterwards are the ones now finding claims denied by plans they thought they participated with. Enrollment drift is the most common Ohio billing problem we are asked to fix.

Enrollment after the managed care restructure

When a state changes its plan lineup, provider participation does not always carry across cleanly, and the symptom is a denial that says the provider is unknown. We verify participation per provider per plan rather than assuming continuity, and treat a non-participating denial as an enrollment task rather than an appeal.

Behavioral health and OhioRISE

Behavioral health billing has its own authorization expectations and its own documentation standard, and OhioRISE adds a separate program on top. It is billed with those rules rather than with a generic medical template, because behavioral health denials do not look like orthopedic denials and do not respond to the same appeal.

Denials worked by reason code

Every denial is categorized by its CARC and RARC rather than handled by whoever opens the file. That is what turns a recurring CO-16 into a fixable intake problem instead of a monthly rework task, and it is the only approach that lowers a denial rate rather than absorbing it.

Ohio Medicaid

Ohio Medicaid runs through managed care plans, with OhioRISE covering children with complex behavioral health needs as a separate program. Each has its own participation requirements.

Program: Ohio Medicaid
Administered by: Ohio Department of Medicaid
Managed care: Ohio Medicaid managed care plans and OhioRISE

Payers we work in Ohio

Medical Mutual of Ohio
Anthem Blue Cross Blue Shield
UnitedHealthcare
Aetna
Humana
Ohio Medicaid managed care plans

Not an exhaustive list, and not a claim of network participation on your behalf — your contracts are yours. It is the payer mix we are set up to work in Ohio.

Services available to Ohio practices

Billing in Ohio — common questions

Our claims are being denied as non-participating. Can you fix that?: Usually yes, and it is normally an enrollment gap rather than a billing error. We confirm participation per provider per plan and work the enrollment, then rebill what is still inside the filing window.
Do you handle OhioRISE?: Yes, as a distinct program with its own rules rather than as ordinary Medicaid managed care.
Do you bill behavioral health in Ohio?: Yes. It is one of the specialties where using generic billing rules causes the most avoidable denials, so it is worked with its own authorization and documentation expectations.
Can you take just our old A/R?: Yes, as a fixed-scope project worked oldest bucket first, with a contingency option, while you keep current billing where it is.

Everywhere else

All billing services

Next step

Start with the free A/R review.

Send an aging summary and a handful of denials. You get a written read on what is recoverable — no fee, no obligation to sign anything.

Book the A/R review See pricing