Posted by Behavioral Health Billing Solutions, LLC.

Ready or not, here it comes. The MCO Carve in is moving forward, full speed ahead, despite a number of reservations, fully documented to the interested parties including all Ohio Senators, the JMOC Committee, all Ohio House representatives and  the heads of ODM and OhioMAS departments.


Below is an email I sent to the Governor’s office that was forwarded to Greg Moody, Barbara Sears, Tracey Plouck and many more. I was promised a response to my concerns but to date have not received one. However, we cannot stop this alone. We need agencies willing to stand up and say “This will devastate my agency, my employee’s and the communities we serve. 


From: Teresa Heim []
Sent: Thursday, June 21, 2018 8:07 AM
To: Hansen, Beth
Cc: Michelene Steinmetz
Subject: Impact of the Managed Care Carve in
Importance: High

Good morning Beth,

I was given your name as a contact for submitting critical information to the Governor’s office. I appreciate your time in reading this and passing it along as you feel is appropriate.

As a behavioral health billing consultant, I deal with a variety of behavioral health agencies across Ohio. Over the weekend, I reached out to several clients and/or contacts to get specific details of the challenges they are currently having in preparation for the Managed Care Carve in.

Below are my key points of concern.

Dependent and paraprofessional registration with Medicaid is extremely low. My estimate is it is 1/4 of where it should be. When Redesign was delayed, it wasn’t until that it was announced that ALL providers needed registered before the Managed Care carve in. It’s a case of too much, too soon. And on top of that, the process is very complex when it comes to paraprofessionals. But let me state, it’s not due to delay in processing on the part of Medicaid, it’s due to the complexity of the process and the burden of having to deal with it at the same time we have to contract with MCO’s.

Also, so you are aware, there’s a question about whether providers with a criminal record can be registered. People in recovery are an excellent resource, unfortunately, a criminal history is frequently involved. Current state, we are being told they may not be able to register with Medicaid even though, Ohio Rule states otherwise.

Second issue, MCO’s are on the same, proper thought process with regard to registration and contracting of type 84/95 providers, but it obviously is not being communicated well to the people doing the actual contracting process. I have several agencies being asked to register as Group practices which involves a substantial amount of unnecessary time including CAQH enrollment or substantial documentation being completed that is not required for BH providers.

Third substantial finding was agencies reporting outstanding revenue owed to them by Caresource either through MyCare, Caresource Just 4 me or CTP. One agency wrote off all Caresource Just 4 me claims and cancelled their contract. Another reported sometime in May, the portal for entering CTP claims just stopped working. In a matter of two months, they have over $16,000 in claims unpaid. The CEO for CareSource reported at JMOC that they are experiencing IT and staffing changes. I did not hear him say this issue was completed or over.

Knowing this information and that they are already behind in payments, why would we move forward until we know their processes are up and fully functional?

Finally, two of the most important issues I want to point out are issues I brought up at the last Medicaid EDI meeting.

One is a change in adjudication that was made in March 2016 that providers were not notified of in advance and to date, no formal notification of this change has been made. At that time, they stopped adjudicating incorrect Medicaid numbers submitted and threw them into an 824 file. However, since no notification went out, agencies never knew to look for these or how to deal with them. This has been going on for a year and a half. I’ve found agencies with 1000 claims impacted in one 824 file. How much money is sitting there waiting for providers to realize there is an issue?

The second item I brought up is since Redesign went into effect. They are accepting claims and attaching denials. Primarily, this is related to add-on claims being incorrectly attached. My concern is many agencies just see an accepted claim. With the delay in processing 835’s, it may take quite a while before they realize their submitted claim of $250.00 was actually paid at $102.31. I strongly feel that a rejected claim will be noticed and addressed, where as an accepted claim is easily missed.

These are all critical revenue pieces impacting agencies currently that combined with the overall recovery process related to Redesign and the additional burden of enrolling all providers, make it critical to delay Managed Care at this time. It is my belief that moving forward with the Managed Care Carve in July 1st would be devastating to the constituents of Ohio.

I would be happy to discuss in more detail. Please feel free to contact me direct at 614-395-0136 for more information or details.

Thank you for your continued support,

Teresa Heim

Behavioral Health Billing Solutions, LLC


Below is the series of responses I received within a very short time of submitting the email. By the way, I got the MITS portal access restored on Thursday through this thread. Start at the bottom and read up.


From: Teresa Heim <>
Date: June 21, 2018 at 4:49:06 PM EDT
To: “Moody, Greg” <>
Cc: “Reidenbach1, Kelly” <>, “‘‘” <>, “Plouck, Tracy” <>, “Tassie, Jim” <>, “Bergefurd, Angela S.” <>
Subject: RE: Impact of the Managed Care Carve in
Thanks for the update. I’m glad to know it was resolved so we can get back to what we do.
Have a nice evening,
Teresa Heim


From: Moody, Greg <>
Sent: Thursday, June 21, 2018 4:23:45 PM
To: Teresa Heim
Cc: Reidenbach1, Kelly; ‘‘; Plouck, Tracy; Tassie, Jim; Bergefurd, Angela S.
Subject: RE: Impact of the Managed Care Carve in
The issue with the portal was a statewide systems issue — not related to MITS — that resolved today at 2:00. Barbara or Tracy will be able to provide you with additional information.
Greg Moody


From: Teresa Heim []
Sent: Thursday, June 21, 2018 12:34 PM
To: Moody, Greg
Cc: Reidenbach, Kelly; ‘‘; Plouck, Tracy; Tassie, Jim; Bergefurd, Angela S.
Subject: RE: Impact of the Managed Care Carve in
Thank you Greg,  I appreciate your assistance and quick response.
By the way, the MITS portal isn’t working today. I’ve been trying to log in for about 15 minutes now. A quick fix would be appreciated if the right people are on this email thread.
Teresa Heim
Behavioral Health Billing Solutions, LLC.


From: Moody, Greg <>
Sent: Thursday, June 21, 2018 12:31:32 PM
To: Teresa Heim
Cc: Reidenbach1, Kelly; ‘‘; Plouck, Tracy; Tassie, Jim; Bergefurd, Angela S.
Subject: RE: Impact of the Managed Care Carve in
Hi Teresa, glad you reached out. As you know, the Ohio Departments of Medicaid and Mental Health and Addiction Services are the lead agencies on Behavioral Health Redesign. I’ve copied Directors Sears and Plouck, who I know are familiar with the issues you raised and to whom your concerns are best addressed.
Greg Moody


From: Teresa Heim []
Sent: Thursday, June 21, 2018 12:08 PM
To: Hansen, Beth
Cc: Reidenbach, Kelly; Moody, Greg
Subject: RE: Impact of the Managed Care Carve in
Thanks Beth, I appreciate your assistance.
Teresa Heim
Behavioral Health Billing Solutions, LLC.


From: Hansen, Beth <>
Sent: Thursday, June 21, 2018 12:06:48 PM
To: Teresa Heim
Cc: Reidenbach1, Kelly; Moody, Greg
Subject: RE: Impact of the Managed Care Carve in
I have copied Greg Moody and Kelly Reidenbach on your email
Thanks for sending to me
Beth Hansen
Office of the Governor


And finally, due to a lack of response to my specific, documented concerns, I sent the email below late on Friday.


From: Teresa Heim <>
Date: June 22, 2018 at 9:29:15 PM EDT
To: “” <>
Subject: Re: Impact of the Managed Care Carve in

Hi Tracey,

I wanted to follow up and see if your meetings resulted in answers to my specific concerns.

The reason for urgency is pretty obvious. We are  8 days away from a change that, in my opinion, could be devastating to the communities across Ohio.

To support my determination in pursuing this delay, let me share additional contacts and info I received today.


I received multiple emails from contacts from different agencies who have been attempting to test with CareSource for a month. After several emails that transpired today, some very heated between one of the agencies and our contact at CareSource (who has been very helpful), that agency finally received responses to their test files. The other situation remains unresolved. 

However, it took getting Senator Burke involved to eventually get a response in both cases.


Another agency reported that Buckeye was still requiring CAQH or an extensive form completed for contracting that is not required for behavioral health providers. A second agency reported the same issue occurring with Buckeye and UHC. I forwarded her info to both of my contacts at the involved MCO’s to resolve because they assured me this issue had been resolved


I talked to two agencies going through the registration process who possibly misunderstood that the questions regarding state and federal offenses applied to the individual providers and not just the owners of the agency.


Fact is the state created lines of services enlisting the assistance of people successful in recovery, however, the current guidelines are preventing them from registering with Medicaid.

These are just a few examples of one day in the life of a consultant who deals with a variety of agencies across Ohio that are in different levels of distress, preparing for something outside of their control, that could devastate their agencies and the communities they serve.

I want to stress that the decisions your departments make in the next few days could impact not only agencies and the communities they serve across Ohio, but will leave a legacy for this administration that will be hard to defend

It’s a case of too much too soon. 

Please consider delaying the carve in until we have time to recover from redesign, payment timeline changes, new provider enrollment requirements and truly prepare for this substantial change.

Thank you for your time and careful consideration.

Teresa Heim, Behavioral Health Billing Solutions, LLC

However, to date, it is moving forward. Be prepared as much as you can.