Ohio Medicaid: Balance billing is not permitted

Check member eligibility and benefits before providing services

We want to remind you that balance billing members is not permitted. You can help eliminate balance billing and remain compliant with the Ohio Department of Medicaid and your UnitedHealthcare Provider Agreement by verifying member eligibility and benefits before you provide services.

What this means for you

You may not balance bill members if:

• The charge amount and the UnitedHealthcare Community Plan fee schedule differ
• Your claim is denied for late submission, unauthorized service or as not medically necessary
• UnitedHealthcare Community Plan of Ohio is reviewing a claim

Also, keep in mind that UnitedHealthcare Community Plan of Ohio and UnitedHealthcare Connected for MyCare Ohio are payers of last resort. If the member has other medical coverage, that carrier is considered the primary payer. When billing UnitedHealthcare Community Plan, please submit the primary payer’s explanation of benefits or remittance advice with the claim, if applicable.

How to check member eligibility

Use either of these 2 methods to verify your patient’s status and help ensure we properly process and pay your claims:

• UnitedHealthcare Provider Portal:
  • Go to UHCprovider.com and click Sign In at the top-right corner
  • Enter your One Healthcare ID
    • New users who don’t have a One Healthcare ID: Visit UHCprovider.com/access to get started
  • Select Eligibility and enter your search criteria

          To learn more about eligibility and benefits, view our training guideopen_in_new.

• Ohio Department of Medicaid:
  • Go to Provider Network Managementopen_in_new and click Login at the top-right corner
  • Follow the instructions on the site

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