Complete Story
 

03/01/2023

Summary of New ODM Initiatives Launched February 1

 

One month ago Ohio Department of Medicaid (ODM) launched the Next Generation managed care plans, new Electronic Data Interchange (EDI), and Fiscal Intermediary (FI). These initiatives provide an enhanced and personalized healthcare experience for ODM members with more transparency and visibility of care and services for providers. 

As a reminder . . .

Where do you submit claims?

For providers who utilize direct data entry (DDE):

For providers who utilize a trading partner:


Where do you edit claims?

Edits to claims, including adjustments and voids, are submitted utilizing the same method (MCE portal, MITS page accessed via the PNM module, or through a trading partner utilizing the new EDI) as the original claim submission. Claims submitted via trading partners are not viewable within the PNM module.


Where do you go for more information on claims?

For claims submitted but not yet paid:

For paid claims:


Do you have questions?

Information is available on the submitting claims and prior authorizations page on the Next Generation website. For additional help contact the Integrated Helpdesk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. Representatives are available during special hours February 1-24:

After February 24, regular hours of 8 a.m.-4:30 p.m. will resume Monday-Friday.


Other Important Reminders:

Update on remittance advices for fee-for-service claims delivered via PNM 

Ohio Department of Medicaid is addressing an issue where fee-for-service remittance advices are unable to be viewed in the Provider Network Management (PNM) module. All fee-for-service remittance advices will be available in the PNM module by Tuesday, February 21, 2023. 


PNM affiliation steps are not complete and may impact provider billing

Through a series of PNM queries, Ohio Department of Medicaid (ODM) has identified several affiliation issues that impact billing organizations claims. It is imperative that providers fully execute all steps when affiliating a rendering provider to their group/organization/hospital to avoid claims payment issues. ODM has identified that providers tend to leave affiliations in one of two incomplete statuses (Affiliation Status):

A provider affiliation can be initiated and completed by the group/organization/hospital, or it can be initiated through the rendering practitioner. If the affiliation is initiated through the rendering individual, it is not complete and remains in a “Pending Approval” status until the group/organization/hospital accepts and saves the affiliation. At that point it will appear as “Confirmed”. For the provider affiliation to be sent downstream and receive an “Active” status, there are two remaining critical steps:

  1. Click at the top of the page, which saves all the updates. Once saved, the user will have a new button appear.  
  2. Click . Users must click on this button to complete the process and submit the affiliations downstream. Affiliations are fully executed ONLY once this final step has been taken.   

Important: If these steps are not completed, the provider affiliation is not sent downstream, and providers will experience claims payment issues. 


For more information

The PNM ‘Learning’ Tab includes step-by-step instructions in three Quick Reference Guides (QRGs) for affiliation assistance.

 

 

In your inbox

 

 

 

Printer-Friendly Version