Statewide Healthcare RCM Coverage • 1,253 Cities & Towns
Medical Billing & RCM Services in Ohio
Delivering tailored medical coding, billing, and credentialing services across Ohio. Serving healthcare providers, clinics, and hospital groups with an exceptional 98% clean claim rate.
Statewide Regulatory & MAC Compliance Hub
Ohio Medicare MAC Jurisdiction & Payer Regulations (J-15)
Comprehensive Part A/B Medicare contractor policies, LCD standards, and state Medicaid filing rules for Ohio medical practices.
98.2% First-Pass Clean Claim Rate
Medicare Administrative Contractor (MAC)
J-15
Jurisdiction 15 (J-15)
Contractor:
CGS Administrators, LLC (HQ: Nashville, TN)
State Medicaid & Public Health Agency
OH
Ohio Department of Medicaid (ODM / NextGen PNM)
Governing Agency:
Ohio Department of Medicaid (ODM)
Medicaid Timely Filing:
365 days from Date of Service / 180 days from Medicare RA
Medicare Timely Filing Window
12 months (365 days) from Date of Service
First-Level Appeals (Redetermination)
120 calendar days from Remittance Advice (Redetermination)
First-Pass Clean Claim Target
98.2% Scrubber Rate
Active Local Coverage Determinations (LCDs) in Ohio (J-15):
4 Active LCDs
L38397
MolDX: Molecular Diagnostic Services
L34170
Outpatient Physical and Occupational Therapy Services
L36504
Hyperbaric Oxygen Therapy (HBOT)
L34241
Nerve Blockade: Somatic & Autonomic
Regional Billing Nuances & Compliance Safeguards:
Ohio Department of Medicaid (ODM) NextGen PNM: Single Pharmacy Benefit Manager (SPBM) and NextGen EDI clearinghouse integration; automated 835 cross-over feeds.
Kentucky Medicaid (KY DMS) Partner Portal: Managed care crossovers with Passport by Molina, Humana Healthy Horizons, WellCare, Anthem.
National DME MAC Jurisdiction C Synergy: CGS also administers national DME MAC Jurisdiction C, providing specialized cross-specialty billing integration for in-office dispensed medical equipment.
Mandatory single-use drug vial wastage recording with JW/JZ modifiers.
Healthcare Locations & Cities in Ohio
Select your city below for specialized local medical billing solutions and regional payer expertise.