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Benefit Coordination Recovery
Benefit Coordination & Recovery Section (BCARS) consists of Cost Avoidance and Buy-In units with clerical support.
Benefit Coordination Recovery

Third Party Liability and Recoveries


Third-party carriers are required to share eligibility information with Medicaid for the purposes of improving cost avoidance.  In State Fiscal Year 2020, Ohio Medicaid avoided $700 million in billed charges up front. Ohio Medicaid recovered $81+ million via pay-and-chase. These amounts represent state and federal shares. The federal share--typically 60 percent--is returned to the federal government.  As for the state share, 40% or $32.4 million was returned through pay-and-chase activities.

Cost Avoidance


Preventing Medicaid payment when other health insurance coverage exists.  Medicaid providers may use the ODM 06614, Health Insurance Fact Form, to inform the Cost Avoidance Unit of changes in third party insurance coverage.  Forms may be faxed to: 614-728-0757.

Pay-and-Chase


Recovering from a liable third party for medical expenses paid by Medicaid.

Payment Coordination


Processing a claim when Medicaid is the secondary payer.

Medicare Buy-In


The Buy-In Unit processes Medicare Buy-In eligibility requests not updated by the county department of job and family services eligibility system.  The Unit also ensures that Medicare premiums are paid for certain groups of consumers.  In addition, the Unit updates, corrects and backdates Medicaid eligibility spans in the state's claims payment system (the Medicaid Management Information System or MMIS) when a county identifies an eligibility interface issue. A provider should work with the county department of job and family services when it feels an eligibility issue exists in MMIS.

Ohio's Cost Avoidance Efforts and Contractor