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On February 1, the new Electronic Data Interchange (EDI) vendor will go-live with responsibility for all EDI HIPAA X12 transactions. This does not include claims submitted through the individual managed care portals or claims submitted to MITS via the Provider Network Management (PNM) module. This includes nursing facilities, ICF-IIDs, and medical services billed by pharmacies that bill through a trading partner (TP) only.
THIS INFORMATION IS INTENDED TO HELP PROVIDERS CHECK THE PROGRESS OF THE TPs THEY WORK WITH FOR THE FEBRUARY 1 OHIO MEDICAID ENTERPRISE SYSTEM (OMES) AND NEXT GENERATION IMPLEMENTATION.
This information can change daily as TPs work through their preparations. Updates to the spreadsheet will be posted to the trading partner page of our website by the end of the day Tuesday and Friday.
Using available information, TPs have been grouped into categories based on their activity and engagement with claims testing, including fee-for-service and managed care claims. It is important that all TPs have completed system configuration and testing by February 1 to ensure provider claims are processed properly with the cutover to the new claims system. Greater TP engagement and testing reduces the risk of delays in claims submission and payment for providers. Based on the level of engagement of TPs, they are grouped into the following categories, using the “shorthand” titles:
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Active: TPs are part of the Ohio Medicaid pilot TP group or have connected and are testing in CERT environment.
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Onboarded: TPs have responded but have not tested in the CERT environment.
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Tepid: TPs have responded but need to complete setup and test.
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AWOL: TPs have not responded to outreach. Please note TPs who notified Ohio Medicaid that they are no longer active have been removed from these lists.
The spreadsheet can be downloaded and sorted. Trading partners are identified by name and ID number.
The link to this information can be found on several pages of the Ohio Department of Medicaid website. You can also directly visit the trading partner webpage.
NOTE: If your TP is not listed as active, please reach out to them directly regarding their readiness. Testing is not required but highly encouraged. For other questions you can email OMESEDIsupport@medicaid.ohio.gov. Thank you.
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