We are excited to share the Ohio Department of Medicaid is continuing its provider awareness and training efforts in preparation for the February 1 launch of the Next Generation program! We will be hosting a 1-hour webinar to share information on the exciting changes Ohio Medicaid providers can expect, including an overview of the transition to the Next Generation managed care plans, Electronic Data Interchange, and Fiscal Intermediary. Additionally, we will discuss key changes and where resources are available to assist providers in the transition.
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Webinar Title
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Webinar Date / Time
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Registration Link
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Next Generation February 1 Launch Provider Webinar
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Thursday, January 19
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Click here to register
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Ohio Medicaid is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws. To request a reasonable accommodation due to a disability, please contact ODM’s ADA coordinator at 614-995-9981/TTY 711, Fax 1-614-644-1434, or email: ODM_EEO_EmployeeRelations@medicaid.ohio.gov at least three (3) business days prior to the scheduled meeting. Further information can be found here: Notice of Nondiscrimination.
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On February 1, 2023, Ohio Department of Medicaid (ODM) will implement the new Electronic Data Interchange (EDI) module as part of the Next Generation program. Please take a moment and read through this email for the top eight things you need to know about the new EDI. To view the new information from our last issue please see here.
#1: The new EDI, supported by the vendor Deloitte, is replacing the current EDI.
On February 1, the new EDI will be the exchange point for trading partners on all claims-related activities including claim status and eligibility. All trading partner claims must be submitted directly to the EDI, regardless of whether the member is receiving benefits through Medicaid fee-for-service (FFS) or one of the Next Generation managed care plans. Please note that MyCare is not included in the Next Generation program and will continue to use current processes.
Providers who submit managed care claims through direct data entry (DDE) will do so via the appropriate managed care portal. All managed care prior authorizations will continue to be submitted to the respective managed care portals or through their respective processes. Additionally, FFS direct data entered claims and prior authorizations will continue to be submitted through the Provider Network Management (PNM) module via a link to Medicaid Information Technology System (MITS).
#2: There is a change in policy about rendering providers on claims.
For EDI‐related claims submissions, ODM now requires one rendering provider per claim at the header level, rather than the detail level, for professional claims for both FFS and managed care recipients. Different rendering providers at the detail level are no longer acceptable. Exceptions for FFS Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) providers are detailed in the Medicaid Advisory Letter 622.
#3: Provider claims submitted to trading partners must use the ODM-assigned Medicaid member ID (MMIS).
The Medicaid ID should be obtained with each visit. The Medicaid ID must be used on all EDI claim submissions. Member eligibility can be verified using the PNM portal, which redirects to MITS, or using the 270 /271 eligibility transaction in EDI.
#4: There will be system downtime leading up to February 1.
As we transition to the new EDI, there will be system downtime for processing of trading partner claims. They are as follows:
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January 25-31: There will be an FFS (837 P/I/D) claims transition period.
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January 30-31: There will be a member and claim inquiry blackout.
During this time ODM will not accept claims submitted via trading partners. Please work with your trading partner to discuss any changes or impacts to your submissions.
#5: *New Information* Pay attention to claims date of service when submitting for adjudication.
Claims with dates of service on or after February 1 must be submitted through the new EDI vendor, Deloitte. Claims with dates of service prior to February 1 should be submitted via the current processes.
#6: Check that your trading partner is authorized to work with ODM.
All clearinghouses or trading partners who are already authorized to submit claims to ODM will continue to have access to submit claims on behalf of providers. Please contact your trading partner to ensure they are ready to transition.
#7: Each managed care claim must include the internal managed care payer ID and a receiver ID.
All managed care claims submitted through the new EDI must include the internal managed care payer ID and a receiver ID. Please see the ODM Companion Guides for a full list of the updated receiver and payer IDs. Please note the payer and receiver IDs for FFS claims have not changed.
#8: Providers must submit attachments in the original method of claim submission.
Claim attachments must be submitted via the same method as the claim submission. For example, for a claim submitted via DDE, an attachment must also be done using DDE. For EDI transactions, please work with your trading partner on how to upload attachments. This is similar to the adjustment policy we detailed in the December 12 edition of the ODM Press.
How to stay informed
ODM will provide more information about the upcoming implementation for members and providers in the coming weeks. In the meantime, please contact the Next Generation mailbox with questions. To learn more about the EDI visit the Ohio Medicaid Enterprise System webpage or contact the EDI mailbox for questions.
Thank you for your continued partnership and support of the Next Generation Ohio Medicaid program.
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On February 1, the new Ohio Medicaid Enterprise System (OMES) Cost Report and Rate Setting Web Portal will go live. This system will be accessed via a link in the Provider Network Management (PNM) system and will be used for submitting cost reports and obtaining trade files. In preparation for this February 1 change training sessions will be held the week of January 9. Registration is available now in the learning management system (LMS), Absorb. Access the job aid and follow the steps to create your account and register for training. The training schedule has been posted and is available on the Next Generation website.
This training is recommended for anyone who will directly access the OMES Cost Report and Rate Setting Web Portal to perform cost report submission functions, retrieve long-term care (LTC) rate packages, and/or retrieve minimum data set (MDS) reports. The training provides an overview of the cost report submission process via the new portal. This system allows for an exchange of information in a secure environment and the upload and electronic storage of documents. For LTC providers, this also includes training on the new online cost report tool. Training is being held for the following provider types:
- Nursing facility (NF).
- Intermediate care facilities (ICF) for individuals with intellectual disabilities (IID).
- Hospital.
- Medicaid School Program (MSP).
- Federally Qualified Health Center (FQHC).
- Rural Health Clinic (RHC).
For your convenience, the OMES Cost Report and Rate Setting Web Portal training schedule is provided below:
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Monday
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Tuesday
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Wednesday
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Thursday
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January 9
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January 10
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January 11
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January 12
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OMES Cost Report and Rate Setting Web Portal including LTC Online Cost Report – NF and ICF-IID
(2 - 4:30 p.m.)
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OMES Cost Report and Rate Setting Web Portal – Hospital
(9 - 10:30 a.m.)
OMES Cost Report and Rate Setting Web Portal – Medicaid School Program
OMES Cost Report and Rate Setting Web Portal – FQHC and RHC
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OMES Cost Report and Rate Setting Web Portal including LTC Online Cost Report – NF and ICF-IID
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OMES Cost Report and Rate Setting Web Portal – Hospital
(9 - 10:30 a.m.)
OMES Cost Report and Rate Setting Web Portal – Medicaid School Program
OMES Cost Report and Rate Setting Web Portal – FQHC and RHC
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Learning management system registration
Absorb, the learning management system (LMS), is where the self-paced and virtual training sessions are accessed. If you do not have an account in the LMS, it’s important that you create one to ensure you can access all training sessions, answer forms, and view a variety of Provider Network Management (PNM) module resources. Access the job aid and follow the steps to create your account and register for training.
Training schedule
The training schedule has been posted and is available on the Next Generation website. Training module topics include:
- Agent setup and assignment.
- Adding/editing/confirming affiliations.
- Completing an update.
- Explanation of why enrollment actions do not display.
- Explanation of current statuses in the PNM module.
- Medicaid Information Technology Systems (MITS) redirection/issues.
- PNM helpful tips.
- Cost reports and rate setting.
- Accessing remittance advice.
For more information
To learn more about the PNM module and Centralized Credentialing, visit the PNM and Centralized Credentialing page on the Next Generation website. If you are experiencing any technical issues accessing the PNM module or have specific questions, please contact Medicaid’s Integrated Helpdesk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. The IHD is open Monday-Friday, 8 a.m. - 4:30 p.m. ET.
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Since the launch of the Provider Network Management (PNM) module on October 1, several affiliation issues have been identified and applicable fixes have been deployed over the past three weeks.
Below is a list of tips and reminders intended to assist you in navigating the PNM module:
- Rendering providers must be affiliated to the billing organizations for specific provider types, this includes Behavioral Health organizations, Federally Qualified Health Centers (FQHCs), and professional medical groups.
- Actions taken in the PNM module begin a workflow that, when completed, sends the updated transaction downstream to the other Ohio Medicaid Enterprise System (OMES) modules. These modules include the single pharmacy benefit manager (SPBM) and Medicaid Information Technology System (MITS).
- In all self-service updates, which include the establishment of affiliations, please remember to complete the workflow by clicking the <SAVE> button for each of the affiliation updates, then clicking the <SUBMIT FOR REVIEW> button. This last step will ensure the transaction is sent downstream to the other modules and subsequently completed. This allows the affiliation to be finalized.
- If you started an affiliation and it remains highlighted in yellow on the affiliations page, it may be best to simply cancel that transaction by clicking on the red “x.” From there, create a new affiliation, save it, then submit for review. It’s possible that a provider organization started the affiliation during the period when PNM fixes were deployed, causing the transaction to be stuck.
Reference guides
The PNM reference guides provide step-by-step instructions for various PNM actions and are continuously being updated. Click the “Learning” Tab in the top menu of the PNM application to access “User Guides” and “Quick Reference Guides.” Please note you do not need to be logged in to access this menu.
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