Medical Billing in Ohio
Soft Home Global provides billing, AR follow-up and denial appeals for Ohio practices and billing companies at $1,650 per seat per month. Full time, worked during Ohio business hours, inside your own system.
What is specific to Ohio
Ohio Medicaid moved to a Next Generation managed care structure with a single front door but multiple plans behind it.
Ohio’s Medicaid programme is Ohio Medicaid. Practices with a meaningful Ohio Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a medical billing seat does in Ohio
Aged accounts receivable called until they close, and denials read, appealed and tracked.
In Ohio the queue that costs the most is Ohio Medicaid: 365 days from the date of service; from discharge for inpatient, and a claim past that date is unpayable rather than late.
- Worklist worked from the difficult end, not the easy end
- Every call logged with the payer reference and the outcome
- Denials categorised so the same reason stops recurring
- Appeals written and submitted, not just re-bills
- Weekly written summary of what moved and what did not
- Worked during Ohio business hours, not queued overnight
Most of the Ohio work we see comes out of Columbus, Cleveland and Cincinnati, though nothing about a seat depends on where your office is — the queue is worked through your system, not from your building.
Ohio borders 5 states, and practices near those lines almost always carry at least one out-of-state Medicaid enrollment. That is a separate portal, a separate filing window and a separate appeal route from Ohio Medicaid, and it is the queue that most often goes unworked because it belongs to nobody.
What Ohio law gives you
30 days to pay or deny a claim submitted on the standard claim form; 45 days if the payer determines reasonable supporting documentation is needed. No electronic vs. paper split in the statute.
Ohio Medicaid, in practice
Managed care through the Next Generation program with seven MCOs — AmeriHealth Caritas Ohio, Anthem Blue Cross and Blue Shield, Buckeye Community Health Plan, CareSource Ohio, Humana Healthy Horizons in Ohio, Molina Healthcare of Ohio, and UnitedHealthcare Community Plan of Ohio — plus the OhioRISE specialty plan for children with complex behavioral needs. Source
Ohio funnels all Medicaid EDI claims — fee-for-service and all seven MCOs — through one state-contracted EDI front door (vendor: Deloitte) rather than letting you submit to each plan, and every Medicaid pharmacy claim goes to a single statewide PBM (Gainwell Technologies), not to the member's MCO. You set up one trading-partner connection for the whole state, and pharmacy is carved out of the MCOs entirely. Source
On the commercial side the dominant Blue plan here trades as Anthem Blue Cross and Blue Shield (in Ohio the trade name of Community Insurance Company), which matters mainly because its portal and its appeal route are the ones your seat will spend the most time in. Source
How long you have to file an Ohio Medicaid claim
365 days from the date of service; from discharge for inpatient, measured from the actual date the service was provided. Denied claims resubmitted, and provider-reported underpayments adjusted, within 365 days of the date of service or discharge.
“Claims are timely if received by ODM within: (a) Three hundred sixty-five days of the actual date the service was provided.” Ohio Admin. Code 5160-1-19 — Submission of medicaid claims
A claim past that date is not late, it is unpayable, and no appeal recovers it. It is the one queue where a week of nobody working it is money that does not come back — which is the argument for working Ohio Medicaid as its own queue rather than mixing it into commercial follow-up. Every state’s limit is listed here.
Working Ohio hours
Ohio runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Ohio hours and nobody else’s.
What it costs in Ohio
$1,650
Per seat, per month, in US dollars — $19,800 a year for one full-time person, forty hours a week, on Ohio hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Ohio run $1,450 to $2,450; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Ohio
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with Ohio practices?
Yes. Ohio accounts are worked during Ohio office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Ohio?
Ohio Medicaid moved to a Next Generation managed care structure with a single front door but multiple plans behind it.
How long do we have to file a Ohio Medicaid claim?
365 days from the date of service; from discharge for inpatient, measured from the actual date the service was provided. Denied claims resubmitted, and provider-reported underpayments adjusted, within 365 days of the date of service or discharge. Past that date a claim is not late, it is unpayable, and no appeal recovers it. Source: Ohio Admin. Code 5160-1-19 — Submission of medicaid claims.
When does a Ohio payer have to pay a clean claim?
30 days to pay or deny a claim submitted on the standard claim form; 45 days if the payer determines reasonable supporting documentation is needed. No electronic vs. paper split in the statute. A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does medical billing cost in Ohio?
$1,650 per seat per month — $19,800 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Ohio queue?
Ohio is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Ohio Medicaid as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Ohio Medicaid has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
Next step
One seat on your Ohio work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com