05/25/2018

Progress on Meetings with Medicaid Managed Care Plans

 

OAMES continues working with the Ohio Department of Medicaid (ODM) and contracted managed care plans to discuss HME issues that have been raised by members and develop communication channels and processes to address concerns.  The meetings are a starting point with mutual dialogue to share observations of both providers and the payer, identify priority concerns and determine processes to resolve issues as they arise on a go-forward basis.  This work began as a result of a meeting OAMES organized in January with all of the plans, key ODM staff and representatives of the Ohio Association of Health Plans. 

To-date, OAMES has met individually with Molina, United Healthcare of Ohio and Aetna Better Health of Ohio. We will soon begin setting up meetings with Buckeye, CareSource and Paramount. The meeting agenda focuses primarily on the following issues with specific details tailored towards each plan:

1. Medical policy deviations between the managed care plan and OAC 5160:10 (DME rule)
2. Prior authorization variances to OAC 5160:10 Appendix DD
3. Claims adjudication issues and variances to Medicaid process
4. Discussion of any known system configuration issues
5. Cleans claims payment timelines
6. Network panel capacity and contracting
7. Any concerns that payers experiences with Ohio DME providers
8. Update on ODM DME rules and CMN forms effective July 16 (assuming adoption)

Thank you to John Reed, past president of OAMES, who has been leading these important discussions along with OAMES executive director Kam Yuricich.  Initial meetings with the MCPs and OAMES are being held with ODM staff and follow-up meetings are being scheduled with the payers directly and at their office location to allow more reps from their team to attend.  

We are already seeing steps for improving communications. For example, Molina recently announced that they are scheduling Durable Medical Equipment Q&A sessions via teleconference for network providers as a result of feedback from OAMES.  One was held on May 8 and a second one is scheduled for June 12.  Click here for the Molina bulletin and additional details.  

We encourage members to continue sharing any problems they are experiencing with any of the MCPs to Kam Yuricich in the OAME office so we can focus on current issues.  The plans will also be participating in OAMES Fall Medicaid Training Seminar on Sept. 13 in Columbus so mark your calendars and watch for registration information later this summer.