Coding and claim mechanics are national. What changes at a state line is everything around them: who adjudicates your Medicare claims and hears your appeals, what your Medicaid program is called and whether a commercial plan sits in front of it, whether an auto injury is the health plan's problem or the auto carrier's — and how a billing company is permitted to charge you.
In Ohio, Medicare is administered by CGS Administrators (J15). Medicaid runs as Ohio Medicaid, delivered largely through commercial managed care plans — so most Medicaid claims are adjudicated by an insurer with its own filing window and authorization rules rather than by the state.
Ohio is a tort state for auto injuries, so standard coordination of benefits applies rather than a no-fault carrier taking first position.
White Glove Medical Billing is a medical billing, coding, and revenue cycle company — not a healthcare provider and not a law firm. All coding is performed by certified coders from your providers' documentation; the clinical record and the certification of medical necessity remain the provider's.
At a glance
Medicare contractor
CGS Administrators (J15)
Medicaid program
Ohio Medicaid
Medicaid delivery
Commercial managed care plans
Auto injuries
Tort state — standard COB applies
Appeals in Ohio
CGS Administrators (J15) is who hears the first level of appeal for a Medicare denial here. That matters practically: an appeal argument that works with one contractor generally works across every state it covers, and local coverage determinations mean the same service can be covered in Ohio and not one state over.
What we handle for Ohio practices
- Medical coding by certified coders, from your documentation
- Charge entry, claim scrubbing, and electronic submission
- Clearinghouse rejection follow-up and denial management
- Payment posting reconciled to your bank deposits
- Aged A/R worked by recoverability, not by date
- Coordination of benefits sequenced across primary and secondary coverage
- Patient statements, payment plans, and a billing support line
A note on Ohio business taxes
Not a service we sell, and not advice — but a practice is still a business with a state footprint, and it comes up often enough to be worth stating. Ohio administers sales tax through the Ohio Department of Taxation. Most clinical services are not taxable, but retail sales — supplements, cosmetics, optical, DME sold rather than billed — frequently are. Employer registration runs through the Ohio Department of Job and Family Services, and the entity itself is registered with the Ohio Secretary of State. Your CPA owns all of it; we mention it because the retail side of a practice is where it usually surfaces.
We work the claims. You practice medicine.
Coding, claim submission, denial management, and A/R follow-up — with nothing left for your front desk to chase.
View pricingHow It Works
Review
We look at your Ohio aging, denial mix, and payer panel.
Scope and price
A written scope, and the Ohio rate card above confirmed in writing.
Transition
Coding and submission move across without a gap.
Report
Six numbers monthly, segmented by payer and provider.
Medical billing pricing in Ohio
Percentage of collections
6–8% of what we collect for you
You pay a share of what actually lands in your account. If a claim is never paid, it costs you nothing — which is the point: it puts us on the same side of the denial as you are.
Every ongoing engagement carries a minimum monthly fee of $500. It exists so a new or small practice can be served properly rather than quoted a percentage that does not cover the work.
What changes the work in Ohio
- Medicare contractor
- CGS Administrators (J15)
- Claims for Ohio providers are adjudicated here, and this is who hears the first level of appeal.
- Medicaid program
- Ohio Medicaid
- Delivered largely through commercial managed care plans, so most Ohio Medicaid claims go to a health plan rather than to the state.
Ohio shares its Medicare contractor with Kentucky, so an appeal that works in one usually works in the others.
Front-end services in Ohio
These are priced per occurrence and are the same in every state. They can be bought on their own, without a billing contract.
| Eligibility check | $5 per patient |
| Full benefits verification | $10–$14 per patient |
| Prior authorization, standard | $12 per authorization |
| Prior authorization, complex | $18–$25 per authorization |
| Patient registration audit | $4 per patient |
What we report every month
- Days in A/R — How long money takes to arrive.
- A/R over 90 days — What share of what you are owed is going stale.
- Clean claim rate — How often a claim is paid without rework.
- Net collection rate — Of what was collectable, how much we collected. The number that grades the whole engagement.
- Denial rate by reason — Grouped by cause, so it points at a fix rather than a total.
- Charge lag — Days from date of service to claim submission — often your number to fix rather than ours, which is exactly why you can see it.
Ohio Guides
Ohio Medical Billing by Specialty
These specialties have medical billing that genuinely differs in Ohio — workers compensation schedules, no-fault auto rules, or Medicaid structure.
Ohio — Frequently Asked Questions
Which Medicare contractor covers Ohio?
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CGS Administrators (J15). That is who adjudicates your Medicare claims, publishes the local coverage determinations that bind you, and hears a redetermination.
Is Ohio Medicaid managed care?
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Ohio Medicaid is delivered largely through commercial managed care plans. Nationally about 78% of Medicaid beneficiaries are in comprehensive managed care, and five companies account for roughly half of that enrollment — so "billing Medicaid" here usually means billing a commercial insurer.
How do you price in Ohio?
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A percentage of collections, banded by practice size. The rate card above shows what applies.
Do we have to be in Ohio to work with you?
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No — we work remotely with practices in all 50 states and DC. What matters is that somebody is tracking Ohio's rules against your actual claims, which is what this page is for.
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