05/02/2024
Ohio Medicaid Announces Updates to Address Fee-For-Service (FFS) Claim Challenges
The Ohio Department of Medicaid (ODM) issued the following update this week. OSMA has been working with the Department on administrative challenges related to FFS claims and hopes these upgrades will address some of the problems practices have been facing.
ODM continues to implement new initiatives and improvements to achieve the program’s mission to focus on the individual and improve the provider experience. As an extension of this effort, we will implement new features in Ohio Medicaid Enterprise System (OMES) modules. Providers will see and utilize these new features in the Provider Network Management (PNM) module beginning on June 30, 2024. Check out the information below to learn more about the benefits providers and other PNM users will experience as a result of this implementation.
What is changing?
The new OMES features in the PNM will increase visibility for providers of claims submitted by trading partners, streamline fee-for-service (FFS) claims and prior authorizations submission, improve self-service functions and access to financial documents. The improvements will allow providers and other PNM users to:
- Complete direct data entry for FFS claims, prior authorization processes, and searches, and complete other administrative activities in the PNM module without being rerouted to 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 in the Electronic Data Interchange (EDI).
- Receive one remittance advice for fee-for-service claims whether they are submitted by direct data entry in the PNM or by a trading partner in the Electronic Data Interchange.
- Find 1099 forms and other financial documents in the PNM without needing to call the Fiscal Intermediary helpdesk.
- Look up member eligibility and hospice enrollment within the PNM, rather than being rerouted to MITS, which will streamline and simplify the processes.
The new features described above impact FFS claims and prior authorizations. There will not be changes to managed care claims and prior authorizations as part of this implementation.
Where can providers find training and resources?
ODM and our system vendor partners will provide trainings and reference guides for providers and PNM users to prepare for the implementation of new features in the PNM module. We will send training registration this week by email and post the information on the Launch Training and Resources page of the Next Generation website.
Will this implementation impact claim submission?
In the coming weeks, we will also provide information about impacts to claims submission and prior authorizations in the period leading up to the upcoming implementation.
We appreciate your support of the Ohio Department of Medicaid as we take the next step in realizing the Next Generation program mission. As always, if you have any questions, please contact us.