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Claim Submission and Adjudication Reminders for Ohio Medicaid Next Generation

Important Message from the Ohio Department of Medicaid


With the launch of the new Electronic Data Interchange (EDI) along with the Fiscal Intermediary (FI) as part of the Next Generation of Ohio Medicaid program on February 1, the EDI became the new exchange point for trading partners on all claims-related activities, providing transparency and visibility regarding care and services. The FI, in conjunction, now assists in routing managed care claims submitted to the EDI and adjudicates and pays fee-for-service (FFS) claims submitted to the EDI.

We understand this transition has adjusted how you submit and access claims. Please refer to the guidance below for direction and reminders on the claim submission process.

Where do you submit claims?

For providers who utilize direct data entry (DDE):

For providers who utilize a trading partner:

Where do you submit claim attachments?

Where do you edit claims?

Edits to claims, including adjustments and voids, are submitted utilizing the same method (MCE portal, MITS page accessed via the PNM module, or through a trading partner utilizing the new EDI) as the original claim submission.

Where do you go for more information on claims?

For claims submitted but not yet paid:

For paid claims:

Additional information on claim submission for providers who utilize trading partners 

With the launch of the new EDI, changes in the claim submission process are required for trading partners to exchange transactions in the new EDI. Providers should work with their trading partners to determine the changes that may be needed to their systems and staff training. A few important changes for providers who utilize trading partners to note are as follows:

Do you have questions? 

Information is available on the submitting claims and prior authorizations page on the Next Generation website. For additional help contact the Integrated Helpdesk (IHD) at 800-686-1516 or Representatives are available during special hours February 1-24:

After February 24, regular hours of 8 a.m.-4:30 p.m. will resume Monday-Friday.

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