Medicare & Medicaid Updates: Important Reminders For Your Practice
Over the last two weeks, OSMA has received a number of updates from CMS and Ohio Medicaid regarding Medicare and Medicaid coverage and reimbursement. Be sure to know the latest information on the MIPS Data Validation and Audit, Medicaid open enrollment process and deadline, and the Medicaid provider revalidation.
The Ohio Department of Medicaid recently notified practices regarding provider revalidation and key information for patients on open enrollment.
Medicaid Provider Revalidation Notices
Ohio Department of Medicaid (ODM) resumed provider revalidation notices in June 2023 as part of the federally required unwinding process from the COVID public health emergency. ODM issues a series of notices with the first one delivered 120 days before your Medicaid agreement end date. Subsequent reminders are issued at 90 days, 60 days, and a final notice at 30 days. If you receive a revalidation notice, it is important that you take action to complete your revalidation on time. All providers are subject to either 5-year or 3-year time-limited provider agreements.
How do you know if you are due for revalidation?
1. Check your mail and email.
Revalidation reminder notices are mailed and emailed to providers who are due for revalidation before the end of their Medicaid agreement. The email will be sent from OHPNM@maximus.com and will advise that there is a revalidation correspondence in the Correspondence folder in Provider Network Management (PNM) module. Please check your spam folder for this email.
2. View the Correspondence folder in the PNM module.
Revalidation notices are posted in the PNM module and can be accessed in the Correspondence folder. Please be sure to select the type of correspondence from the drop down (in this case ), and search for the “Revalidation Notices.” Review the Accessing Communications within PNM Quick Reference Guide for step-by-step instructions.
NOTE: If you think you are due for revalidation but have not received notices, please login to the PNM module and verify that the primary contact information is accurate in accordance with your Ohio Medicaid Provider Agreement. All mailers and email notices are directed to the primary contact individual or address identified in the system.
If I am due for revalidation, what action do I need to take?
A “Begin Revalidation” option appears in the PNM Enrollment Action Selections 120 days before the Medicaid Agreement end date. This can be found under the “Manage Application,” “Enrollment Actions” option within the provider file. Review the Revalidation/Reenrollment Quick Reference Guide for step-by-step instructions.
Credentialed providers whose revalidation date has passed will not see the “Begin Revalidation” option. ODM expects to provide the “Begin Revalidation” option for these credentialed providers through the PNM module starting October 26.
If you are currently in a PNM revalidation cycle, it is important that you take immediate action to complete and submit your revalidation to renew your Ohio Medicaid Provider Agreement. However, ODM is NOT currently terminating providers that fail to revalidate. As a reminder, revalidations resumed following the end of the public health emergency for providers due October 1 and after.
Medicaid Open Enrollment Happens This Month
Medicaid Open enrollment runs now through November 30 and is the time when Ohio Medicaid members can review the available plans and select the plan that best fits their healthcare needs. If a member would like to stay with their current healthcare plan, they do not have to take any action related to open enrollment.
Members can select a new plan by using the Ohio Medicaid Consumer Hotline Portal at www.ohiomh.com or by contacting the Ohio Medicaid Consumer Hotline at 800-324-8680. Representatives are available 7 a.m. – 8 p.m. Monday through Friday and Saturdays 8 a.m. – 5 p.m.
Resources available to help your practice answer member questions:
There are several supplemental resources linked below to help you and your staff respond to Ohio Medicaid member questions about 2024 managed care annual open enrollment.
- The Ohio Medicaid’s managed care organizations health plan comparison provides an overview of the services that all managed care plans offer as well as the specific value-added services available from each individual plan.
- The find a provider search tool can help members identify which managed care plans their trusted providers are contracted or "in network" with.
- The Open Enrollment FAQ answers questions related to annual managed care open enrollment.
- The What is open enrollment? micro video provides an overview of what annual open enrollment is and the resources available to members.
- Each managed care plan has a member website that members can visit to learn more about their approach to serving Ohio Medicaid managed care members:
For more information:
For technical support or assistance, contact Ohio Medicaid’s Integrated Helpdesk (IHD) at 800-686-1516 and follow the prompts for Provider Enrollment (option 2, option 2) or email IHD@medicaid.ohio.gov. Representatives are available Monday-Friday, 8 a.m.-4:30 p.m. Eastern time.
CMS Notice Regarding MIPS
The MIPS DVA for Performance Year (PY) 2022 will begin November 2023.
The Centers for Medicare & Medicaid Services (CMS) has contracted with Guidehouse to conduct data validation and audits (DVAs) of MIPS eligible clinicians or groups in accordance with the legislative authority set forth in 42 CFR 414.1390(a)-(d). This regulation requires MIPS eligible clinicians or groups to comply with data sharing requests, providing all data as requested by CMS. Data validation and audits are designed and conducted to confirm the accuracy and completeness of reported results of the MIPS program.
If you are selected for the MIPS DVA, an email will be sent to the Security Official in your Health Care Quality Information Systems Access, Roles, and Profile (HARP) account. Please review that the contact information is up to date in the HARP system. The email will be sent from Guidehouse (MIPS_DVA_Request@guidehouse.com).
MIPS participants selected for DVA can expect notification of selection and initial requests for information starting November 2023 through March 2024. There may also be ad hoc DVA work that is conducted through 2024. You will have 45 days from the date of the notice to provide the requested information of substantive, primary source documents. These documents may include: copies of claims, medical records for applicable patients, or other resources used in the data calculations for MIPS measures, objectives, and activities. Primary source documentation also may include verification of records for Medicare and non-Medicare patients where applicable.
Please note, failure to provide the requested information for the DVA could result in a payment adjustment in accordance with the legislative authority set forth in §§ 405.980 through 405.986. It may also increase the possibility that you will be selected for future DVA. If a third-party is used for MIPS data submission, MIPS participants are accountable to ensure that all requested audit documentation is provided in a complete and timely manner.
Please refer to the Merit-based Incentive Payment System (MIPS) Data Validation and Audit (DVA) Factsheet for PY 2022 for additional information at MIPS DVA Fact Sheet PY 2022 (PDF, 226KB). If you have questions pertaining to the DVA, please contact Guidehouse at MIPS_DVA@guidehouse.com.
Or you may contact the Quality Payment Program Service Center at 1-866-288-8292, Monday through Friday, 8 a.m. – 8 p.m. ET or by e-mail at: QPP@cms.hhs.gov. Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.