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, our seven Next Generation managed care plans will begin serving members with an increased emphasis on personalized care. At the same time, ODM's new Electronic Data Interchange (EDI) and the Fiscal Intermediary (FI) will go live.
What can providers expect on February 1?
Of the February 1 launch, the new EDI and FI will impact providers the most. As we phase in these new system components, some of your day-to-day processes will change while some will remain the same. Read on to understand how you will be affected.
Claims and prior authorization (PA) submitted through trading partner
- ODM’s new EDI begins accepting trading partner fee-for-service (FFS) and managed care claims.
- Provider claims submitted to trading partners must include the Medicaid member ID (MMIS).
- Medicaid ID should be obtained with each encounter.
- Member eligibility can be verified using the ID through the Provider Network Management (PNM) module, which redirects to MITS.
- For professional claims, only one rendering provider is allowed per claim. Individual claims must be submitted for services rendered by different providers. Exceptions for FFS Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) providers are detailed in the Medicaid Advisory Letter 622.
What is not changing February 1?
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FFS PAs will continue to be submitted to the PNM module.
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Managed care PAs will continue to be submitted to each plan using their existing processes.
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The new EDI will not accept PAs of any kind.
Portal submitted claims and all prior authorizations
What are the key changes on February 1?
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All Next Generation plans will have portals for direct data entry.
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MMIS ID will be the identifying number used for FFS claims processing.
What is not changing February 1?
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Continue using managed care plan portals to direct data enter claims and PAs.
- Plan eligibility will continue to be accessed through MCO portals.
- Continue using the PNM module, which redirects to MITS, as you do today to submit, adjust, and search FFS claim and PA information.
ODM will continue to use the ODM Press to provide information about the upcoming implementation for providers. In the meantime, please reach out to the Next Generation mailbox with questions. Thank you for your continued partnership and support of the Next Generation Ohio Medicaid program!
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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.
- 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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