Since 2022- Ohio has introduced a separate BH plan-OhioRise- is a managed care program for children and youth that require a complex behavioral treatment program. This program is provided by Aetna Better Health of Ohio.

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The members may qualify for OhioRISE plan and be enrolled automatically or later on.

While the members can qualify to be enrolled into the plan, for any medical and some BH services the member’s MCO plans would pay or Ohio Medicaid Fee for Service. One of those services is:

• ABA services

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Coding:

• Claims for ABA services (HCPCS codes 97151-97158, 0362T, and 0373T) for Autism Spectrum Disorder.

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Medical Billing: Ohio no longer accepts paper claims. Provider can submit through:

• EDI- for list of authorized partners please visit- https://medicaid.ohio.gov/Provider/Billing/TradingPartners/AuthorizedTradingPartners
• Or submit directly via MITS-Medicaid Information Technology System: please click here for more info https://medicaid.ohio.gov/resources-for-providers#1615193-mits-resources

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Phone: Medicaid Provider Call Center at 1-800-686-1516

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