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This communication is important for certain Medicaid providers who submit claims for reimbursement through the Electronic Data Interchange (EDI), including the service of trading partners. This does not apply to direct data entry (DDE) claims submitted through Ohio Department of Medicaid (ODM) and managed care entity (MCE) portals.
You are receiving this because you are a trading partner or the known contact person for your provider organization. The billing provider needs this information in order to consider opting in for the bridge payments, so please send this to your billing provider and your fiscal staff.
As part of our Next Generation program transition, 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. Please view the provider bridge payment memo for complete information.
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 EDI claims directly to the MCEs for all claims regardless of dates of services. FFS claims will still need to be submitted to OMES Deloitte EDI.
- Temporary bridge payments – the provider must opt-in.
ODM is also providing an opportunity for certain billing providers to opt-in to be considered to receive temporary bridge payments due to delays in processing claims through ODM and MCE IT systems. To be eligible to potentially receive temporary bridge payments, a provider must (1) “opt-in” by providing information to ODM through an online form at the following Bridge Funding | Medicaid (ohio.gov) and (2) meet all additional program eligibility criteria described in the attached memo.
DODD providers that directly bill ODM through MITS, including Intermediate Care Facilities and Individual Options Waiver providers rendering nursing services (billing codes T1002 and T1003), are not eligible for bridge payments because their claims are not impacted by the new EDI submission process. DODD providers that use a trading partner to submit EDI claims may be eligible for the bridge payment program if they opt-in and they meet all of the criteria outlined above. Since ODA waiver providers are paid by the PASSPORT Administrative Agency, they are not impacted by these changes and are not eligible for bridge payments.
Providers with questions about use of the Provider Network Management module and those experiencing challenges with DDE claims through ODM or the MCEs should contact ODM’s Integrated Helpdesk (IHD) at 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.
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