Filing Claims

Payments by BCMH to providers of services are regulated by relevant sections of the Ohio Revised Code, the Ohio Administrative Code and the BCMH Provider Agreement.

Guidelines for Submitting Claims to BCMH

·         Claims must be received by the BCMH within 11 months of the date the service was provided.   BCMH will reject claims that do not meet this time frame.

·         BCMH will pay only for services or goods that have been authorized for payment by BCMH and have been provided by BCMH-approved providers.

·         Providers may bill BCMH no more than the provider customarily charges other patients for the same goods and services.

·         Providers must submit claims only on forms prescribed by BCMH.

·         Claims submitted to BCMH that are incomplete or not properly completed will be returned to the provider to be corrected.

·         Providers will be paid by BCMH for inpatient hospital care, outpatient care and all other medical assistance furnished by hospitals in accordance with reasonable cost principles established by the Medicare program, and for all other goods or services in accordance with the fee schedule set forth in the BCMH manual of operational procedures and guidelines.

·         All claims submitted to BCMH for payment are subject to verification by BCMH staff.  BCMH may contact providers, insurance companies, employers, families and others, as necessary, to request further information or verification.

Claims for payment by BCMH should be submitted to:

Bureau for Children with Medical Handicaps

PO Box 1603

Columbus, OH  43216-1603

Pharmacy Point of Sale

The BCMH utilizes an electronic point of sale (POS) system to adjudicate all drug claims from pharmacies.  The POS system is administered by a contracted pharmacy benefit manager, the same contractor as used by Medicaid.  The POS system does not adjudicate claims for medical supplies, special formula and equipment.  These claims must be submitted to BCMH on a CMS 1500 form for payment.  For more information on the BCMH POS program, please contact a BCMH third-party management analyst at (614) 466-1700.

More specific information is available on the following topics:

·         Billing instructions for CMS 1500

·         Billing instructions for dental

·         Billing instructions for CMS 1450, UB 04

·         Claim error reasons (codes and descriptions)

·         Co-pays and deductibles

·         Insurance-covered claims

·         Medicaid covered claims

·         Non-payable codes

·         Pharmacy claims processing

·         Submitting claims for adjustment

·         Submitting claims to BCMH when there is other third-party coverage

Updated 3/1/2009