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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 BCMH fee schedule.
  • 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:
Children with Medical Handicaps Program (BCMH)
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.  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:

 

Last Updated: 6/29/2017