Ohio Behavioral Health Redesign: What It Means for Your Organization

Stay ahead of Medicaid Next Generation changes with Etactics’ proven clearinghouse expertise.

The Ohio Behavioral Health Redesign has reshaped how behavioral health providers submit and get paid for Medicaid claims. From new managed care entities (MCEs) and payer IDs to OhioRISE and the Fiscal Intermediary system, these changes have created major challenges for agencies.

Etactics has been on the frontlines of every redesign phase, helping agencies adapt quickly while keeping cash flow steady.

What Is the Ohio Behavioral Health Redesign?

Ohio launched the Behavioral Health Redesign to modernize Medicaid and improve access to care. It unfolded in multiple phases:

• 2018 – Medicaid introduced managed care for addiction treatment and mental health, creating more payers and more complex billing rules.
• 2022 – OhioRISE launched to coordinate behavioral health care for children and youth across multiple systems.
• 2022–2023 – The Next Generation Medicaid Program rolled out in stages, adding new MCEs, centralized credentialing, a statewide pharmacy benefit manager, and the Fiscal Intermediary to streamline claims routing.

While the goals are admirable, the changes have dramatically increased the administrative load on providers and billing teams.

The Challenges for Behavioral Health Agencies

For most agencies, the redesign has meant:

• Increased payer complexity – Multiple MCEs, each with new payer IDs and rules.
• Claims routing confusion – Dates of service before vs. after December 1, 2022 required different submission workflows.
• Policy number requirements – Medicaid ID numbers became mandatory on many claims.
• ERA disruptions – Agencies struggled to reconcile remittance advice from multiple sources.
• Risk of denials – Even small setup mistakes led to rejected claims and lost revenue.

Left unmanaged, these challenges can overwhelm billing teams and threaten organizational stability.

How Etactics Helps Agencies Navigate the Redesign

Etactics simplifies the Ohio Behavioral Health Redesign by providing:

• Automated Claim Routing
  Our system automatically adjusts payer IDs and ensures claims are directed correctly, preventing costly rejections.
• Consolidated ERA Management
  Receive Medicaid FFS and MCE remits in one place instead of tracking across multiple systems.
• Trusted Medicaid Partner
  As an ODM Pilot Clearinghouse, we’ve tested and validated transactions directly with the state.
• Proven Track Record
  We support over 80 Ohio behavioral health agencies representing more than 3,000 providers, giving us unmatched experience in this space.
• Denial Management Expertise
  From split claims to rejections tied to redesign rules, we help agencies recover revenue quickly.

Case Study: The Village Network

When Ohio Medicaid introduced new billing rules, The Village Network faced a surge in denials. Manual processes couldn’t keep up with the added complexity. By partnering with Etactics, the organization reduced denial rates by 30% and established reliable workflows for future Medicaid updates.

The Current State of Ohio Medicaid

Today, the Next Generation Medicaid program is live. New managed care entities like Humana, Anthem, and AmeriHealth Caritas are active, OhioRISE is operating statewide, and the Fiscal Intermediary is routing claims.

But the system continues to evolve—and payer rules continue to shift. Etactics ensures our clients stay informed and updated, minimizing disruption to billing and reimbursement.

Frequently Asked Questions

What is the Ohio Behavioral Health Redesign?
It’s a statewide initiative to modernize Medicaid, improve care coordination, and expand managed care.

How does the redesign affect billing?
Agencies must use new payer IDs, Medicaid IDs, and claim routing rules. Without proper setup, claims are often denied.

What is OhioRISE?
OhioRISE (Resilience through Integrated Systems and Excellence) provides specialized behavioral health care for children and youth.

What role does the Fiscal Intermediary play?
It centralizes claim submission and remittance, reducing administrative burden—but requires clearinghouse alignment.

How can Etactics help my agency?
We handle claim routing logic, ERA management, payer ID updates, and denial resolution—so your team can focus on patient care.