Behavioral Health Carve-In

CareSource is here to support you with providing and being reimbursed for Behavioral Health Carve-In services. Here you can find valuable information on a variety of topics, including:

• Contracting
• Support
• Additional Resources

Contracting

We are excited to partner with you. To start the contracting process, please complete the following.

• Visit Become a CareSource Provider
• Complete the New Health Partner Contract Form.
• Need help? Refer to the User’s Guide for Completing the New Health Partner Contract Form.

You will need your group’s:

• IRS name
• Tax ID number
• NPI number(s) for each ODM/OhioMHAS specialty (Mental Health: 84 and/or Substance Use Disorder: 95, etc.)
• W9

Groups going through the initial contracting process may also be required to submit a roster of rendering providers for each ODM/OhioMHAS specialty (Mental Health: 84 and/or Substance Use Disorder: 95, etc.).

Your roster should contain:

• Group information: Tax ID, Tax ID, Medicaid ID, Group NPI, Group Name, Mental Health or Substance Use Disorder, City, State, Zip
• Practitioner information: Medicaid ID, NPI, Last Name, First Name, Type and Specialty
• Inclusion of multiple or DBA (doing business as) names, if applicable
• Additional location information

Subsequent rosters of rendering providers affiliated with a group will be drawn from and validated through ODM’s MITS system. Please make sure to keep your group’s affiliated rendering providers up-to-date in MITS. Failure to do so may result in claims adjudication issues.

Support

CareSource has dedicated behavioral health customer service representatives available to answer your questions about benefits, claims, member eligibility and more.

Call CareSource at 1-800-488-0134 if you have questions or concerns. We are available Monday to Friday, 7 a.m. to 6 p.m.

Additional Resources

Provider Portal

Submit claims, check claims status, check for known claims processing issues in the Claims Payment Systemic Errors (CPSE) report, review member eligibility, and view payment information.

• Visit the Provider Portal to get started. (Note: you will need a CareSource ID number to register.)
• Need help? View the Provider Portal Registration Training Module.

Prior Authorization

Information on CareSource’s Prior Authorization process can be found on the CareSource Prior Authorization page.

• Submit the universal Navigate Ohio Association of Health Plans form to request prior authorization for outpatient behavioral health services.
• Navigate Ohio Urine Drug Screening Prior Authorization Form – Submit this form when requesting prior authorization for urine drug screenings
• Submit the Navigate SUD 1115 Waiver Universal PA Form to request prior authorization for residential and partial hospitalization Substance Use Disorder (SUD) services.

Claims Appeals

Information on how to dispute or appeal a claims decision can be found on CareSource’s Provider Appeals page.

Benefit Grids

Navigate MyCare and Medicaid Outpatient Hospital Benefit Grid – Use this benefit grid to understand the hospital covered services for behavioral health services.

Navigate MyCare and Medicaid CBHC (Community BH Centers) Benefit Grid – Use this benefit grid to understand the community behavioral health center covered services for behavioral health services.

Navigate MyCare and Medicaid Opioid Treatment Programs (OTP) Benefit Grid– Use this benefit grid to understand the Ohio Department of Medicaid (ODM) and Mental Health and Addiction Services (Ohio MHAS) Opioid Treatment Program (OTP) Medicaid covered services for providers already enrolled as a provider type 95 (community substance use disorder program) with provider specialty 950 AND either licensed by OhioMHAS as a methadone treatment administration program (provider specialty 951) AND/OR certified by the Substance Abuse and Mental Health Services Administration (SAMHSA) as an OTP (provider specialty 953) may request the addition of a provider specialty for methadone administration and/or buprenorphine based medication administration.

Navigate MyCare and Medicaid Group Medical Practices Benefit Grid – Use this benefit grid to understand the covered services for behavioral health services provided by Group Medical Practices.

Navigate MyCare and Medicaid Specialized Recovery Services (SRS) Benefit Grid – Use this benefit grid to understand the covered services for Specialized Recovery Services (SRS) Program [1915(i)]. The SRS program is available to individuals who meet certain financial criteria and have been diagnosed with a serious and persistent mental illness (SPMI). Individual eligibility and program enrollment criteria are detailed in Administrative Code rule 5160-43-02. In addition to full Medicaid coverage, individuals enrolled in the SRS program have access to these new services: Individualized Placement and Support-Supported Employment (IPS-SE) and Peer Recovery Support (PRS).

For general Behavioral Health Redesign questions, please visit the ODM/OhioMHAS Redesign website.