Health Plan Matrix :: Nationwide Children's Hospital

Payor Matrix

Always check with your health plan for the most up-to-date coverage.

Nationwide Children's Hospital

Payor Nationwide Children's Hospital** NCH Guidance Center Children's Anesthesia Associates Children's Surgical Associates Corporation Pediatric Academic Associates Children's Radiologic Institute Pediatric Pathology Associates of Columbus
Yes Yes Yes Yes Yes Yes Yes
Aetna Yes Yes Yes Yes Yes Yes Yes
Anthem BC BS and Anthem Ohio Health Exchange Plans Yes Yes Yes Yes Yes Yes Yes
Beacon Behavioral Health (formerly Value Options) No No No No No No No
Buckeye Community Health Plan (Ohio Medicaid Managed Care) Yes Yes Yes Yes Yes Yes Yes
Bureau for Children w/ Medical Handicaps (BCMH) Yes Yes Yes Yes Yes Yes Yes
CareSource (Ohio Medicaid Managed Care) Yes Yes Yes Yes Yes Yes Yes
CareSource Just4Me (Ohio Exchange Plan) Yes Yes Yes Yes Yes Yes Yes
CIGNA/Great West/GWH Yes No Yes Yes Yes Yes Yes
CIGNA Behavioral Health No No No No No No No
Coventry Cares of WV (WV Medicaid Managed Care) & Coventry Health Care of WV (Commercial) Yes Yes Yes Yes Yes Yes Yes
First Health Yes Yes No No No No No
Frontpath Health Coalition (Toledo & 80 reg hosp) Yes Yes Yes Yes Yes Yes Yes
Health Smart (formerly Emerald Health) Yes Yes No No No No No
Yes Yes No No No No No
HealthSpan and HealthSpan Ohio Exchange Plans Yes Yes No No No No No
Humana and Humana Ohio Exchange Plans Yes Yes No No Yes No No
Magellan Behavioral Health No Yes No No No No No
Medical Mutual Ohio (MMO)/SuperMed and MMO Ohio Exchange Plans Yes Yes Yes Yes Yes Yes Yes
Molina (Ohio Medicaid Managed Care) Yes Yes Yes Yes Yes Yes Yes
Ohio Health Choice Yes Yes Yes Yes Yes Yes Yes
OhioHealth Group/Health Reach Yes Yes Yes Yes Yes Yes No
OSU Health Plan OSU Student Health Plan University & Regional Univ Prime /Care Mary Rutan Hosp (EBMC) Ohio Wesleyan Univ Yes Yes Yes Yes Yes Yes Yes
Ohio Medicaid (Traditional) Yes Yes Yes Yes Yes Yes Yes
Paramount Advantage (Ohio Medicaid Managed Care) Yes Yes Yes Yes Yes Yes Yes
PHCS-Private Healthcare Systems Yes Yes No No No No No
The Health Plan (Commercial and WV Medicaid Managed Care) Yes Yes Yes Yes Yes Yes Yes
Tricare/Champus Yes Yes Yes Yes Yes Yes Yes
UHC Community Plan (Ohio Medicaid Managed Care) Yes Yes Yes Yes Yes Yes Yes
United Healthcare Commerical (Includes Golden Rule, Oxford, River Valley, and UMR) Yes Yes Yes Yes Yes Yes Yes
United Behavioral Health No Yes No No No No No
UniCare (Commerical Only)
Yes Yes No No No No No
Notes: **Nationwide Children's Hospital contract includes Outpatient Surgery Centers, ChildLab, Outpatient Diagnostic Radiology, Clinical Therapy (PT, OT, Speech), and Urgent Care
KEY:
Yes = Nationwide Children's Hospital does participate with this plan for this service.
No = Nationwide Children's Hospital does NOT participate with this plan for this service.

 

 

Nationwide Children's Hospital Homecare

Payor

Nursing, Skilled Therapies, Aide Services

Infusion Therapy

Injectables (Drugs)

Home Medical Equipment

Private Duty Nursing

Hospice

Factor

Aetna In Network for NCH Employees & Ohio Health Employees ONLY

Yes

Yes

Yes

Yes

Yes

Yes

Contact office. Determined on case by case basis.

Aetna –Out of Network Referrals through CSI
(614)293-2273
(888) 873-7888

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Anthem - Out of Network Referrals through CSI
(614)293-2273
(888) 873-7888

Referrals go through CSI

to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI

to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

Referrals go through CSI to Access NCH Homecare

BCMH

Therapies only

Yes

Yes

Yes

Yes

No

Yes

Buckeye Community Health Plan (Ohio Medicaid)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

CareSource

(Ohio Medicaid)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

CareSource Just 4 Me

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Cigna – Out of Network Referrals through CareCentrix
(800) 411-2305

Referrals go through CareCentrix to Access NCH Homecare

Referrals go through CareCentrix to Access NCH Homecare

Referrals go through CareCentrix to Access NCH Homecare

Referrals go through CareCentrix to Access NCH Homecare

Referrals go through CareCentrix to Access NCH Homecare

Referrals go through CareCentrix to Access NCH Homecare

Referrals go through CareCentrix to Access NCH Homecare

Front Path Health Coalition

Yes – When patient is in Homecare Service Area

Yes - When patient is in Homecare Service Area

Yes When patient is in Homecare Service Area

Yes - When patient is in Homecare Service Area

Yes When patient is in in Homecare Service Area -

Yes - When patient is in Homecare Service Area

Yes - When patient is in Homecare Service Area

Medical Mutual of Ohio

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Medicare

No

No

No

No

No

No

No

Molina

(Ohio Medicaid)

Yes

Yes

Yes

Yes

Yes

Yes

No

Ohio Health Reach (Optima Health is a TPA for this plan)

Yes

Case-by-Case

Case-by-Case

Yes

Case-by-Case

Yes

Case-by-Case

OSU Managed Health Care Systems

(Coresource is a TPA for this plan)

Yes

Yes

Yes

Yes

Yes

Yes

Case-by-Case

Ohio Medicaid (Traditional)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Paramount Advantage

(Ohio Medicaid)

Yes

Yes

Yes

Yes

Yes

Yes

No

Tricare Prime/Standard

Yes

Yes

Yes

Yes

Yes

Yes

We can service some patients, must check specific plan. Determined on case-by-case basis.

UHC Community Health Plan (Ohio Medicaid)

Yes

Yes

Case-by-Case

Yes

Yes

Yes

Case-by-Case

United Health Care                             (UHC)

Yes

Yes

Yes for Synagis. All others, contact office. Determined on case-by- case basis.

Yes

Yes

Yes

Contact office. Determined on case-by-case basis.

NOTE: All services need prior authorization before beginning services.

If a particular payor plan is not listed above, please contact Nationwide Children's Hospital Homecare

at 1-614-355-1100 /1(800) 466-2727 for verification.

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000