01/17/2023

What to Expect with the February 1 Launch of Next Generation of Ohio Medicaid

Last Chance to Register for Jan. 19 Provider Webinar for the Latest

The Ohio Department of Medicaid's 1/13/2023 list-serve article on the Next Generation managed care program:

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. Exceptions for FFS Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) providers are detailed in the Medicaid Advisory Letter 622.

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.

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For additional information, be sure to participate in ODM's Next Generation one-hour webinar for providers on Thursday, Jan. 19. Click here to register.