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 Association 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 Exchange Plan PPO 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 Marketplace (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
Humana Yes Yes No No Yes No No
Magellan Behavioral Health No Yes No No No No No
Medical Mutual Ohio (MMO)/SuperMed 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 Commercial (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 (Commercial 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

Intermittent Nursing and Skilled Therapies

Infusion Therapy

Injectables (Drugs)

Home Medical Equipment

Private Duty Nursing

Hospice and Palliative Care

Factor

Synagis

Aetna Health Inc.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

 

Yes

 

Anthem

Yes

Yes

Yes

Yes

Yes

Yes

 

Case-by-Case

Yes

Buckeye Community Health Plan (Ohio Medicaid)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

CareSource

(Ohio Medicaid)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

CareSource Marketplace

(Formerly CareSource Just4Me)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

CMH – Children with Medical Handicaps (Formerly BCMH)

Case-by-Case

Case-by-Case

Case-by-Case

Case-by-Case

Case-by-Case

Case-by-Case

Case-by-Case

Case-by-Case

Cigna - 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

Referrals go through CareCentrix to Access NCH Homecare

Front Path Health Coalition

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Medical Mutual of Ohio

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Medicare

No

No

No

No

No

No

No

No

Molina

(Ohio Medicaid)

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Ohio Healthy (Formerly Ohio Health Reach (Optima Health is TPA)

Yes

Case-by-Case

Case-by-Case

Yes

Case-by-Case

Yes

Case-by-Case

Case-by-Case

OSU Managed Health Care Systems

(Coresource, & NGS are TPAs)

Yes

Yes

Yes

Yes

Yes

Yes

Case-by-Case

Case-by-Case

Ohio Medicaid (Traditional)

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Paramount Advantage

(Ohio Medicaid)

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Tricare Prime/Standard

Yes

Yes

Yes

Yes

Yes

Yes

Case-by-Case

Yes

UHC Community Health Plan (Ohio Medicaid) / (UMR – United Medical Resources is TPA)

Yes

Yes

Case-by-Case

Yes

Yes

Yes

Case-by-Case

No

United Health Care (UHC)

Yes

Yes

Case-by- Case

Yes

Yes

Yes

Case-by-Case

Yes

NOTE: Call Nationwide Children's Hospital Homecare at 1(614) 355-1100 /1(800) 466-2727 where Homecare is listed in-network, for verification of services and prior authorization.

Cigna plans require referrals call Care Centrix for benefit verification and prior authorization. If a particular payor plan is not listed here, please call Nationwide Children's Hospital Homecare and ask to speak with a Prior Authorization Representative for clarification or confirmation of coverage. Homecare referral hours are Monday thru Friday, 8 a.m. – 4:30 p.m. (Excluding National Holidays)