As a reminder, the provision in paragraph K of 5160-27-03 that allows behavioral health providers to submit third-party claims to the MCO after 30 days and one attempt of billing without a response from the third-party payer (TPP) instead of the standard 90 days and three attempts will be ending June 30, 2022. This exception was temporarily implemented through a Medicaid State Plan Amendment (SPA) and has an end date tied to procurement, meaning BH providers will resume following the 90 days and three attempts outlined in paragraph C(6) 5160-26-09.1 starting July 1. As a reminder, the Next Generation MCO contracts will continue to require MCOs to allow 365 days for claims submission.

The Ohio Council was able to confirm that the third party liability (TPL) bypass list will remain in effect through procurement. CMS requires states to periodically review their TPL bypass codes and ODM is working through this process, they are only able to include codes that are not otherwise covered by TPPs.