Ohio Department of Medicaid Updates on Next Generation Program Transition
As we have been informing members since late last year, the Ohio Department of Medicaid (ODM) transitioned significant parts of its programming on Feb. 1 – this included a new electronic data exchange and fiscal intermediary as well as some new managed care organizations. ODM has provided this update (below) on some key elements of the program and some issues that are currently being resolved.
Next Generation bridge payments for providers
As part of our Next Generation program transition, Ohio Department of Medicaid (ODM) developed extensive monitoring and a variety of contingency plans. Specifically, Ohio Medicaid is now initiating extra measures to minimize provider disruption and ensure payment continuity. We apologize for the inconvenience, particularly for those who have gaps in payment.
ODM is taking two steps to assist trading partners and providers with the February 1 and Ohio Medicaid Enterprise System (OMES) transitions:
Temporary Redirection of EDI claims from OMES to the MCEs
For the next few months, ODM will temporarily approve active trading partners that are having challenges with OMES to submit Electronic Data Interchange (EDI) claims directly to the managed care entities (MCE) for all claims regardless of dates of services. Fee-for-service (FFS) claims will still need to be submitted to OMES Deloitte EDI.
ODM is working with MCEs to confirm the ability to successfully receive claims directly from the active trading partners and expects to follow up in two weeks with additional information regarding the temporary change. In the meantime, trading partners are encouraged to continue submitting managed care claims via OMES.
Important things to note:
- Trading partners do not need to establish new connections to OMES or the MCEs. If your trading partner sends your claims to another entity that connects to OMES or the MCEs that relationship does not need to change. The entity that submits the claims to OMES/MCEs will be the one potentially permitted to revert to the previous submission path.
- Prior to February 1, trading partners did not connect directly with the MCEs but rather to their designated vendors such as Availity or CHC. A new submission route does not need to be created. These entities will change the dates of services and trading partners that will be accepted by them.
Temporary Bridge Payments—the Provider must Opt-In
ODM is also providing an opportunity for certain Medicaid billing providers who submit claims for reimbursement through EDI, including the service of trading partners to opt-in to be considered to receive temporary bridge payments due to delays in processing claims through ODM and MCE IT systems. This does not apply to direct data entry (DDE) claims submitted through the Ohio Department of Medicaid (ODM) and managed care entity portals.
To be eligible to potentially receive temporary bridge payments, a provider must (1) “opt-in” by providing information to ODM through an on-line form at the following Bridge Funding | Medicaid (ohio.gov)
and (2) meet all additional program eligibility criteria described in the linked memo
Providers with questions about use of the provider network module and those experiencing challenges with DDE claims through ODM or the MCEs should contact ODM’s Integrated Helpdesk (IHD) 800-686-1516 or IHD@medicaid.ohio.gov
or their contracted MCE. Questions about the information in this memo should be directed to: ODMBridge@medicaid.ohio.gov
Thank you for your care and support of Ohioans and your patience, as we implement this new system.