August 2025 Top of Mind

Prevent Medicaid claim edits and get paid faster

Starting in August, providers will notice claim edits on Medicaid denied claims when services are billed concurrently. Luckily there are some easy ways to avoid claim denials – and get paid faster.

Claim edits explained

Ohio Department of Medicaid requires Optum Behavioral Health to provide these claim edits, or reasons for denial. Why? To help ensure you’re paid according to state statutes, policies and billing practices.

What to do if you see claim edits

If your claim is denied, you’ll see claim edits as part of the decision. To submit a corrected claim, check that the claim:

• Matches the allowable place of service codes
• Adheres to benefit limitations and exclusions when services are billed concurrently
• Includes the proper modifiers

Proactively checking this info before you submit claims is one of the best ways to avoid delays and get paid faster and accurately.

Questions?

For more information, please visit the Resources for Providers section of the Ohio Department of Medicaid website. For relevant billing info, please see the Ohio Medicaid Behavioral Health Manual or applicable Ohio Administrative code.

For additional questions, please contact your dedicated provider advocate or Optum Behavioral Health Provider Services at 1-877-614-0484, 7 a.m.–4 p.m. CT, Monday–Friday.