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News update

Apr 14, 2026

OhioRise Enrollment Will Begin On The First Day Of The Month Of Eligibility

Starting July 01, 2026, OhioRISE enrollment will begin on the first day of the month a member becomes eligible.

This update comes from the Ohio Department of Medicaid under rule 5160-59-02. The change aligns enrollment with managed care timelines and reduces the need for retroactive enrollments, especially for inpatient behavioral health cases.

What providers should know?

Review workflows for services provided before and after the enrollment date
Submit claims based on the updated OhioRISE timeline
Coordinate with managed care plans, which remain responsible for CANS assessments completed before enrollment
Track updates to the OhioRISE Mixed Services Protocol as the change rolls out

Questions? Support is available.

Providers can connect through 24/7 chat via the UnitedHealthcare Provider Portal.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

Eligibility Verification

Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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