12/12/2022

February 1 Launch of Next Generation of Ohio Medicaid

The following message is from the Ohio Department of Medicaid:

Over the past year, Ohio Department of Medicaid (ODM) has prepared for and successfully launched many components of the Next Generation Ohio Medicaid program. Our implementation has consistently followed two of our key Next Generation commitments – to focus on the individual and improve the provider experience. ODM remains committed to listening to members, providers, and managed care plan partners, and we have taken a hands-on approach to resolving implementation issues that providers have experienced.  

Based on your feedback, ODM updated its launch timeline to ensure a smooth transition. So, on February 1, our seven Next Generation managed care plans will begin serving members with an increased emphasis on personalized care. At the same time, ODM's new Electronic Data Interchange (EDI) and the Fiscal Intermediary (FI) will go live. 

What can providers expect on February 1? 

Of the February 1 launch, the new EDI and FI will impact providers the most. As we phase in these new system components, some of your day-to-day processes will change while some will remain the same. Read on to understand how you will be affected. 

Claims and prior authorization (PA) submitted through trading partner 

• ODM’s new EDI begins accepting trading partner fee-for-service (FFS) and managed care claims.
• Provider claims submitted to trading partners must include the Medicaid member ID (MMIS).
• Medicaid ID should be obtained with each encounter.
• Member eligibility can be verified using the ID through the Provider Network Management (PNM) module, which redirects to MITS.
• For professional claims, only one rendering provider is allowed per claim. Individual claims must be submitted for services rendered by different providers. (See exceptions for Federally Qualified Health Centers and Rural Health Clinics in “Rendering Provider on Claims Submissions.”)

What is not changing February 1? 

• FFS PAs will continue to be submitted to the PNM module. 
• Managed care PAs will continue to be submitted to each plan using their existing processes. 
• The new EDI will not accept PAs of any kind. 

Portal submitted claims and all prior authorizations 

What are the key changes on February 1? 

• ​All Next Generation plans will have portals for direct data entry.  
• MMIS ID will be the identifying number used for FFS claims processing.  

What is not changing February 1? 

• Continue using managed care plan portals to direct data enter claims and PAs.  
• Plan eligibility will continue to be accessed through MCO portals.  
• Continue using the PNM module, which redirects to MITS, as you do today to submit, adjust, and search FFS claim and PA information. ​ 

How to stay informed 

ODM will continue to use the ODM Press to provide information about the upcoming implementation for providers. In the meantime, please reach out to the Next Generation mailbox with questions. Thank you for your continued partnership and support of the Next Generation Ohio Medicaid program!