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On June 30, the Ohio Department of Medicaid (ODM) implemented new features in the Ohio Medicaid Enterprise System (OMES). Providers can now see and use these new features in the Provider Network Management (PNM) module.
What changed for providers and PNM users?
The new OMES features in the PNM increase visibility for providers of claims submitted by trading partners, streamline fee-for-service (FFS) claims and prior authorizations submission, and improve self-service functions and access to financial documents. The Fiscal Intermediary now processes and adjudicates all FFS claims and prior authorizations. Providers and PNM users can now:
- Complete direct data entry for FFS claims and prior authorizations, conduct claims searches, and complete other administrative activities in the PNM module without being rerouted to the Medicaid Information Technology System (MITS).
- Complete claim adjustments and voids in the PNM for any FFS claims, whether they are submitted by direct data entry in the PNM or by a trading partner via the Electronic Data Interchange.
- Receive one remittance advice for FFS claims whether they are submitted by direct data entry in the PNM or by a trading partner via the Electronic Data Interchange.
- Find future 1099 forms and other financial documents in the PNM without needing to call the Integrated Helpdesk (IHD). To retrieve 1099 forms for past tax years providers will need to call the IHD.
- Look up member eligibility within the PNM, rather than being rerouted to MITS, which streamlines and simplifies the process.
- Look up hospice enrollment within the PNM, rather than being rerouted to MITS.
The new features impact FFS claims and prior authorizations. There were no changes to managed care claims and prior authorizations as part of this implementation.
What resources are available to assist providers?
We understand that this is a big change, and we appreciate your contributions that have made the Next Generation program possible. ODM developed resources to help providers with this implementation. We encourage you to read and share the following:
Do you have questions?
If you have questions related to OMES-submitted claims, prior authorizations, or other administrative processes, contact the IHD at 800-686-1516 or IHD@medicaid.ohio.gov. The IHD is open Monday-Friday, 8 a.m.-4:30 p.m. Eastern time.
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