Dear AmeriHealth Caritas Ohio Provider,
This notice is to inform you of an update to AmeriHealth Caritas Ohio claims system configuration, effective May 1, 2026. This update aligns with the language in the Ohio Department of Medicaid Behavioral Health Provider Manual published on March 24, 2026 and the Ohio Administrative Code Rule 5160-27-08: Section D: Limitations.
As part of this update, please be advised that the following codes cannot be billed on the same day as substance use intensive outpatient code (H0015), the partial hospitalization code (H0015 TG), or for per diem services. This applies even if the services are billed on the same day by different providers.
- H2020
- H2012 (over 1 hour)
- H0038 HQ (over 4 units)
- 90853 (over 1 hour)
- 90849 (over 1 hour)
- H0005 (over 4 units)
- H0036 HQ (over 4 units)
- H2019 HQ (over 4 units
- T1002 HQ (over 4 units)
Claims dated for services rendered after May 1, 2026, will be processed in alignment with the updated guidance; AmeriHealth Caritas Ohio will NOT be retroactively reviewing previous payments.
We encourage you to review your billing practices to ensure compliance with these changes. If you have any questions, please refer to the Behavioral Health Provider Manual or contact our provider services team for assistance at 1-833-644-6001. You can also reach out directly to your account executive via email OhioProviderServices@amerihealthcaritasoh.com.
