Ohio Department of Medicaid (ODM) is issuing an update to independent and agency providers regarding bridge payments and other Next Generation topics.
PROVIDERS CAN STILL OPT IN TO RECEIVE A BRIDGE PAYMENT. The deadline to opt-in to be considered to receive a bridge payment has been extended to March 31, 2023. You must register and provide information to ODM through an online form at the following link: Bridge Funding | Medicaid (ohio.gov).
Please also review the revised ODM memo found here for complete information on the bridge payment program. One provision of the opt-in requirements has changed. Potential redirection of claims to the managed care entities (MCE) is not required. Providers and trading partners are only expected to be actively working with the Ohio Medicaid Enterprise System (OMES) Electronic Data Interchange (EDI) to submit their claims.
The other eligibility requirements remain unchanged. You should not try to resubmit your previous claims through the portal. Please continue to work with your trading partner for claims submission as you are now.
The remainder of this communication provides updates on other important topics.
ODM is not approving any trading partner to submit EDI claims directly to the MCEs. The original memo from ODM indicated we were assessing whether to do this; however, we have determined that the direct submission of claims by trading partners (TP) to MCEs is not needed and would create an inconsistent provider experience across MCEs.
ODM’s analysis of the EDI experience to date indicates the redirection of EDI claims directly to the MCEs would not alleviate the challenges providers are facing with claims payment since many of these issues are related to providers’ fee-for-service (FFS) claims.
ODM is taking several additional steps to improve the FFS payment rate. Edits within the fiscal intermediary (FI) are being relaxed to ensure claims accepted by the EDI system are not rejected by the FI system. Claims previously rejected by the FI due to edits that are being relaxed will be reprocessed automatically and do not need to be resubmitted.
We are seeing a number of important and positive measures regarding the functioning of the systems, with improvements and progress evident week to week. When we compare February to the prior six-month period, we see that claims are processing and paying at, or reasonably close to, the same historical average. However, an average means some providers are higher and some are lower. We consider a negative impact on any individual provider to be significant, which is why we initiated the bridge payments and why individual technical assistance is being given to providers. We have heard your concerns and take them seriously.
For trading partners with lower acceptance rates, ODM is examining errors to identify common causes and provide specific guidance to improve the successful transmission of claims. ODM is also carefully monitoring suspensions, denials, and payment rates to ensure consistency with historic standards.
Providers and/or trading partners experiencing EDI claim issues should contact ODM’s Integrated Helpdesk (IHD) at 800-686-1516. Additional resources related to claims submission can be found on ODM’s website here:
Questions regarding this communication should be sent to ODMBridge@medicaid.ohio.gov.
