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New 'Hospital Acquired Conditions' Policy - Effective January 1, 2022

Buckeye continually reviews and updates our payment and utilization policies to ensure that they comply with industry standards, while delivering the best patient experience to our members. We want to inform you of a new policy Buckeye Community Health Plan will be implementing effective January 1, 2022.

Beginning January 1, 2022, Buckeye Community Health Plan’s adjudication of claims that include Hospital Acquired Conditions will follow current industry practice and align with CMS guidelines.

Upon implementation, Buckeye may deny or reduce reimbursement for claims that include these conditions in accordance with current CMS regulations. You can see the full policy details on CMS. Note: the CMS policy is subject to update and change.

OH Enhanced (NCDs) Guidelines Claims Xten Provider Notification

Buckeye Community Health Plan is committed to continuously improving its claims review and payment processes. Effective 10/01/2021, for Medicare, we will enhance several correct coding edits based on industry standards and coding rules. 

Enhanced NCD Guidelines Claims Xten

OH Correct Coding Guidelines Flexible Prov Matching Provider Notification

Buckeye Community Health Plan is committed to continuously improving its claims review and payment processes. Effective 10/01/2021 for Medicaid, Marketplace and Medicare lines of business, we will enhance several correct coding edits based on industry standards and coding rules. 

Correct Coding Guidelines Flexible Prov Matching