Medicaid Announces Start Date for New Fiscal Intermediary—What to Know
After announcing earlier this month the delay of the transition to new Medicaid Managed Care Organization (MCOs) until Feb. 1, the Ohio Department of Medicaid (ODM) has now announced the same start date for the new Electronic Data Interchange (EDI) and Fiscal intermediary (FI). ODM released the following information earlier this week.
On February 1, 2023, the Electronic Data Interchange (EDI) will launch along with the Fiscal Intermediary (FI) as part of the Next Generation of Ohio Medicaid program. The EDI will be the new exchange point for trading partners on all claims-related activities, providing transparency and visibility regarding care and services. The FI, in conjunction, will assist in routing managed care claims submitted to the EDI, and adjudicate and pay fee-for-service (FFS) claims submitted to the EDI. In preparation for this exciting launch, ODM is providing additional information about claim adjudication.
Where can you edit managed care claims?
Beginning February 1, all managed care claims submitted by trading partners must be sent to the new EDI. These claims will flow through the FI and route to the appropriate managed care entities (MCE) for processing and payment. Providers who submit managed care claims through direct data entry (DDE) will do so via the appropriate managed care portal. Edits to claims, including adjustments and voids, should be submitted utilizing the same method (EDI or managed care portal) as the original claim submission.
Where can you edit fee-for-service claims?
Beginning February 1, all FFS claims submitted by trading partners must be sent to the new EDI and will flow to the FI for processing and payment. Providers who submit FFS claims through DDE will continue to do so through the Provider Network Management (PNM) module via a link to Medicaid Information Technology System (MITS). FFS claims submitted through the PNM module will continue to be paid by OAKS, the State of Ohio’s accounting system. Edits to claims, including adjustments and voids, should be submitted utilizing the same method (EDI or PNM module via a link to MITS) as the original claim submission.
Where will providers go for more information on claims?
All payers' .pdf remittance advices (RA) will be available to providers on the PNM portal. This includes MITS, FI, and MCO RAs.
If a provider is enrolled with ODM to receive an 835, that enrollment will apply to both FFS and MCO activity. The 835s from all payers will be delivered by the trading partner.
How to stay informed
ODM will provide more information about the upcoming implementation for members and providers in the coming weeks. In the meantime, please contact the Next Generation mailbox with questions. To learn more about the EDI visit Ohio Medicaid Enterprise System or contact the EDI mailbox for questions. To learn more about the FI, visit the Fiscal Intermediary page or for questions contact the FI mailbox. Additionally, please see our Training and Resources page for information about PNM refresher training.
Thank you for your continued partnership and support of the Next Generation Ohio Medicaid program.