Ohio billing rewards attention to routing. The state’s Medicaid members are spread across competing managed care plans, youth behavioral health runs through a separate statewide plan, and commercial mental health benefits are frequently carved out to a different vendor than the medical plan. A claim routed to the wrong plan or the wrong benefit manager is a denial, even when everything else about it is correct.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Ohio practices of every specialty, built around the state’s actual payers and programs.
Ohio’s payer landscape
Ohio Medicaid is delivered through managed care plans including CareSource, Molina Healthcare of Ohio, Buckeye Health Plan, Anthem Blue Cross and Blue Shield, UnitedHealthcare Community Plan, AmeriHealth Caritas Ohio, and Humana Healthy Horizons in Ohio. Members with both Medicare and Medicaid are served through the MyCare Ohio program, whose plans include Anthem, Buckeye, CareSource, and Molina. Youth behavioral health services run through OhioRISE, administered by Aetna, which covers children and adolescents with the most significant needs, so a practice treating minors must know when a service belongs to OhioRISE rather than the child’s general managed care plan.
Commercial coverage runs through Anthem Blue Cross and Blue Shield and the major national carriers, and commercial mental health benefits are often carved out to managed behavioral health organizations, meaning a clinician in-network with the medical plan can still be denied by the vendor that owns the therapy benefit.
What MedPlus RCM handles for Ohio practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with Ohio Medicaid plans, MyCare Ohio plans, commercial payers, and Medicare, plus re-credentialing maintenance.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Columbus, Cleveland, Cincinnati, Toledo, and Dayton, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results Ohio practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
What is MyCare Ohio?
MyCare Ohio is the managed care program for Ohioans enrolled in both Medicare and Medicaid, combining both benefits under one plan. Its plans include Anthem Blue Cross and Blue Shield, Buckeye Health Plan, CareSource, and Molina Healthcare of Ohio.
What is OhioRISE?
OhioRISE is the statewide plan for children and adolescents with significant behavioral health needs, administered by Aetna. Practices treating minors need to route eligible services to OhioRISE rather than the child’s general managed care plan.
Do you work with Ohio Medicaid managed care plans?
Yes. We bill CareSource, Molina Healthcare of Ohio, Buckeye, Anthem, UnitedHealthcare Community Plan, AmeriHealth Caritas Ohio, and Humana Healthy Horizons, as well as commercial and Medicare plans.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your Ohio practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
