There are no changes to home and community-based waiver processes, nor to managed care processes.
Beginning August 1, 2025, the Ohio Department of Medicaid (ODM) will deny claims submitted without an approved prior authorization under the Fee-For-Service (FFS) policy. This change is critical to ensure compliance with Ohio Medicaid’s updated requirements.
To help you prepare for this transition, ODM has developed a comprehensive support plan:
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Training Opportunities: Beginning June 25 through August 5, ODM, in partnership with PNM and FI, will offer ten (10) two-hour training sessions. These sessions are designed to walk through the updated prior authorization process. We strongly encourage all providers to attend at least one session.
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Warning Period: Starting July 1, 2025, claims submitted without the required prior authorization will receive a detailed warning in the remittance advice. This is your opportunity to correct submissions before denials begin.
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Enforcement Begins: On August 1, 2025, claims without proper prior authorization will be denied.
Please note that all claims remain subject to post-payment review. Since providers have already been instructed to submit prior authorizations, we anticipate minimal disruption. However, attending training will ensure you are fully prepared and confident in navigating the updated process.
Thank you for your continued commitment to providing quality care while maintaining compliance with Medicaid policies.
Registration steps for enrolling through the learning management system
Access the Absorb Learning Management System to register for the training. If you do not have an Absorb account, you must create one to access all training sessions, answer forms, and view various PNM module resources. For help, please see our job aid and follow the steps to create your account and/or register for training.
For more information
To learn more about the PNM module and Prior Authorization, visit the Provider Education and Training Resources page on the PNM portal. If you are experiencing technical issues accessing the PNM module or have specific questions, please contact the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov. The ODM Integrated Helpdesk is open 8:00 a.m.-4:30 p.m. Monday-Friday, Eastern time.
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