BHBS Ohio Medicaid Schedule & Revenue Forecasting Engine

⚠ Risk Flag - forecast, not claim adjudication. The engine uses the supplied ODM community behavioral health workbook as the reference rate ceiling, then applies entered attendance, realization, payer-factor, and rule assumptions. It does not verify member eligibility, agency certification, practitioner enrollment, prior authorization, place of service, telehealth, diagnosis, documentation, NCCI edits, or payer-specific contract terms.

Source currency check Evaluating the public reference source dates.

Build perspective

Synthetic scenario label (no PHI)

Example template

Workbook reference

Scheduled rate ceiling before forecast factors.

Estimated payable

After charge, rule, and payer-factor assumptions.

Expected weekly revenue

After attendance and claim realization.

Expected monthly run-rate

Recurring week converted to monthly estimate.

Booked provider hours

0.0

Calendar time, not member-hours.

Expected revenue / hour

0 active risk flags.

Scenario context

Defines level-of-care and policy checks.

Program / level of care

Coverage pathway

Billing pathway The supplied workbook directly supports the community BH agency pathway.

Member age context

Payer / plan label

Youth in public child welfare custody Apply July 2026 MCO utilization threshold overlay

Provider credential

Used for all services in a provider-week model.

Default rendering practitioner

Supervisor for direct-pricing scenarios HP/HT supervisor pricing is resolved only when the selected workbook row supports it.

Forecast assumptions

Keep scheduled value separate from expected realization.

Payer rate factor

Attendance / completion

Clean-claim realization

Weeks per month

Weekly clinical capacity hours

Unit method Timed services use completed whole units by default. Enter a manual unit count on an event when the applicable billing rule or payer configuration supports a different unit method.

Member utilization already used

Optional units since Jul. 1, 2026 for threshold forecasting.

Rule and forecast review

High-risk conflicts are surfaced before the scenario is relied upon.

0 checks

Utilization threshold outlook

Member-specific when the member-week perspective is selected.

Scheduled service detail and calculation trail

Reference rate, resolved modifiers, units, rule adjustments, and expected revenue by event.

Date / time	Member / caseload	Rendering practitioner	Service	Unit logic	Reference	Payable	Expected	Monthly expected

Credential comparison view Select independent, dependent, trainee, peer, care-management, or QMHS categories to compare workbook eligibility and resolved reference rates. Direct supervisor pricing requires an eligible HP/HT supervisor selection.

Service and practitioner rate catalog

All rows are retained so modifier- and setting-specific rate differences stay visible.

Show rows eligible for the primary practitioner

Code / modifiers	Service	Program / unit	Primary rate	Comparison rate	Eligibility / notes

⚠ Risk Flag - community BH workbook scope. In this application, "Independent BH professional" is an ODM rendering-practitioner category in the community BH workbook. A practitioner billing through an independently enrolled, non-community-BH practice may fall under OAC 5160-8-05 and a different fee schedule. The app shows a comparison warning rather than treating the community BH workbook as controlling for that pathway.

Calculation methodology

How the schedule becomes an operational forecast.

Included policy guardrails

The engine flags conflicts; it does not replace clinical or payer review.

Known exclusions from this MVP

Items that require payer, credentialing, clinical, or claim-system integration.

Authoritative source inventory

Workbook checksum and policy sources used by the public reference edition.

Source status Workbook SHA-256: . The workbook is retained as the rate/eligibility source; Ohio law and current payer policy control when they conflict.

Public edition and data-use notice

What this edition includes, stores, and excludes.

Public reference scope

This edition uses public Ohio Medicaid reference sources only. It does not contain BHBS claims-derived 837/835 payment benchmarks, client-agency data, provider identifiers, or member data.

Device-local storage

Scenario entries are stored only in this browser. BHBS does not receive the scenario through this standalone application. Use synthetic labels only and select Clear saved data before leaving a shared device.

Terms and privacy

Use is subject to the public tool terms and privacy notice. Review them at any time from the footer. Questions may be sent to inquiries@bhbillingsolutions.com.