Ohio Department of Medicaid COVID-19 and Mpox Resources and Guidelines for Providers. For more information about Medicaid MCPs, please visit the Managed Care web page or refer to the MyCare Ohio and MCP Pharmacy Reference Guide. Through this link, providers will be able to submit and adjust fee-for-service claims, prior authorizations requests, hospice applications, and managed service providers/hospital/long term care cost reports. Additional information is available in the following Ohio Administrative Code (OAC) Chapters: Chapter 5101:2-1 Children Services Definition of Terms Chapter 5122-29 Requirements and Procedures for Behavioral Health Services Ohio Medicaid CANS billing code and payment rate methodology that will become effective July 1, 2022. The Ohio Department of Medicaid has many programs and initiatives to enhance the quality of care for patients and support our providers in the work they do each day. Learn about and compare MyCare plans that are currently available in your area. The Ohio Department of Medicaid has many programs and initiatives to enhance the quality of care for patients and support our providers in the work they do each day. . Aetna The Ohio Department of Medicaid provides an EVV system at no cost to all providers. Page 5 . Providers that billed through the portal using direct data entry and received an advance payment will see recoupment on the December 22 payment. PROVIDER REQUIREMENTS AND REIMBURSEMENT MANUAL . As of Oct. 1, providers will utilize the new Provider Network Management (PNM) module to access the MITS Portal. The next generation of Ohio Medicaid managed care is designed to improve wellness and health outcomes, support providers in better patient care, increase transparency and accountability, improve care for children and adults with complex behavioral needs, and emphasize a personalized care experience. Please check this webpage often to stay current with all updates. Fee-for-Service pharmacy claims are processed by ODMs contracted single pharmacy benefit manager (SPBM) in an online, real-time environment which allows the dispensing pharmacist access to the terms of coverage. . The Ohio Department of Medicaid (ODM) provides health care coverage to more than 3 million Ohioans through a network of more than 165,000 providers. These reimbursement policies apply to our Ohio Medicaid plan. Actions. Cost Report, Rate Setting, Case Mix, Prior Authorization FAQs, Fact Sheets, Other Resources. The UnitedHealthcare Community Plan care provider administrative manuals contain helpful information on topics such as prior authorization, processing claims and protocol information, as well as UnitedHealthcare contact information and other resources. Anthem Blue Cross and Blue Shield (Anthem) is committed to supporting you in providing quality care and services to the members in our network. The Ohio Department of Medicaid is dedicated to being a national leader in health care coverage innovation. A lock or https:// means you've safely connected to the .gov website. The provider may not charge the consumer a down payment, refundable or otherwise. Provider Manuals for Medicaid Plans by State > Find Your State. The prescriber may choose an alternative product or may call a designated toll-free number to request prior authorization (PA) for the product originally prescribed. The changes we make will help you more easily access information, locate health care providers, and receive quality care. Learn more about Ohio's largest state agency and the ways in which we continue to improve wellness and health outcomes for the individuals and families we serve. &Ac0H2NUo30120g`! ,B Page 6 . We are redesigning our programs and services to focus on you and your family. Easily find information in this manual using . In collaboration with our state agency partners, business partners, and stakeholders, we develop innovative payment and service models designed to deliver quality care, improve health outcomes, and lowers costs. Rendering Provider on Professional Claims Submissions, Ambulatory Surgery Center Billing Guidelines for Dates of Service On or After 9/1/2021, COVID-19 Comprehensive Billing Guidelines (6/29/2023), Home- and Community-Based Services Provider Rate Increases, Telehealth Billing Guidelines Effective 07/15/2022, Telehealth Billing Guidelines for Dates of Service 11/15/2020 thru 07/14/2022, Telehealth Billing Guidelines for Dates of Service 3/9/2020 through 11/14/2020, Telehealth Billing Guidance for Dates of Service for 7/4/2019 through 03/08/2020, SCT Transportation Service Billing Guidance, Telemedicine Billing Guidance for Dates of Service Prior to 7/4/2019, Web Portal Billing Guide for Professional Claims, EDI Companion Guide for Professional Claims, Nursing Facility Billing Clarification for Hospital Stays, Web Portal Billing Guide for Institutional Claims, EDI Companion Guide for Institutional Claims, For Dates of Discharge and Dates of Service On or After 9/1/2021, For Dates of Discharge and Dates of Service On or After 7/1/2018 and Before 8/31/2021, For Dates of Discharge and Dates of Service On or After 8/1/2017and Before 6/30/2018, For Dates of Discharge and Dates of Service On or Before 7/31/2017, HOSPITAL UTILIZATION REVIEW AND ASSOCIATED CLAIM RESUBMISSION Desk Aid, Web Portal Billing Guide for Dental Claims. CMS Chicago Regional State Letter # 3695, Original claims must be received by Ohio Department of Medicaid (ODM) within 365 days of the actual date the service was provided. Ohio Medicaids Next Generation managed care plans provide a personalized approach to support your healthcare needs. ) Ohio Medicaid Members - Update your Contact Information. OhioRISE (Resilience through Integrated Systems and Excellence) to social media. Policy updates and links to submission instructions for various cost reports. If you're asked to log in with an OHID - the state's best-of-breed digital identity - your privacy, data, and personal information are protected by all federal and state digital security guidelines. A lock or https:// means you've safely connected to the .gov website. Here, you will find information for assessing coverage options, guidelines for Clinical Utilization Management (UM), practice policies, and support for delivering benefits to our members. . A lock or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites. Provider billing and data exchange related instructions, policies, and resources. Appendix: Ohio Medicaid List of Place of Service Codes 96. Hospice Basic Billing Training, Enrollment Guide. A centralized portal to reduce the administrative burden on providers by streamlining the process for provider certification. Consumer Hotline: 800-324-8680 | Provider Integrated Helpdesk: 800 . The next generation of Ohio Medicaid managed care is designed to improve wellness and health outcomes, support providers in better patient care, increase transparency and accountability, improve care for children and adults with complex behavioral needs, and emphasize a personalized care experience. Inpatient hospital claims must be received within 365 days from the date of discharge. Not already Contracted to Sell for CareSource? lock For additional information, please visit: https://managedcare.medicaid.ohio.gov/providers. Secure .gov websites use HTTPSA Medicaid. 0 An Ohio.gov website belongs to an official government organization in the State of Ohio. Through this link, providers will be able to submit and adjust fee-for-service claims, prior authorizations requests, hospice applications, and managed service providers/hospital/long term care cost reports. An Ohio.gov website belongs to an official government organization in the State of Ohio. DISCLAIMER: Beginning October 1, 2022, the prescription drug coverage for members of Medicaid Managed Care Plans (MCPs) is the responsibility of the Single Pharmacy Benefit Manager (SPBM) and the information available on this page will not apply to MCP members. U8 = Social Worker Assistant . Providers also will be able to verify recipient eligibility and update trading partner information. Billing and Submission 90 Chapter 13: Claim Reconsiderations, Appeals and Grievances 99 This page contains resources for the Ohio Medicaid provider community, including policy and advisory letters, billing guidance, Medicaid forms, research, and reports. Pharmacy Provider Manual Billing Procedure Guide Administered by: Change Healthcare Effective: August 26, 2022 Revised: August 26, 2022. If you're asked to log in with an OHID - the state's best-of-breed digital identity - your privacy, data, and personal information are protected by all federal and state digital security guidelines. Effective Oct. 1, 2022, providers will utilize the new Provider Network Management Module (PNM) to access the MITS Portal. What is National Provider Identifier (NPI)? Disclaimer about fee schedule and rates available for providers. Web Content Viewer. %%EOF A lock or https:// means you've safely connected to the .gov website. The Ohio Medicaid drug program is a federal and state supported program that provides prescription drug coverage to eligible recipients. This page contains resources for the Ohio Medicaid provider community, including policy and advisory letters, billing guidance, Medicaid forms, research, and reports. 9 | Page Legal Disclaimer: ODM strives to make the information in . Rule 5160-56-06. In 2003, we transformed the CMS Program Manuals into a web user-friendly presentation and renamed it the CMS Online Manual System. If you are unable to change health plans online at this time, there are several other options available to you. Effective Oct. 1, 2022, providers will utilize the new Provider Network Management Module (PNM) to access the MITS Portal. For example, if a provider submits a claim via an MCE portal, the provider must then use the same MCE portal to view or edit their claim. The Ohio Department of Medicaid (ODM) provides health care coverage to more than 3 million Ohioans through a network of more than 165,000 providers. Ohio Department of Medicaid | 50 West Town Street, Suite 400, Columbus, Ohio 43215, Consumer Hotline: 800-324-8680 | Provider Integrated Helpdesk: 800-686-1516. We want to be sure all members receive information about the programs Next Generation services and supports for children, youth, and their families. Consumer Hotline: 800-324-8680 | Provider Integrated Helpdesk: 800-686-1516. The link also allows providers to submit cost reports for managed service providers, hospitals, and long-term care. website belongs to an official government organization in the United States. Official websites use .govA Ohio Medicaid is changing the way we do business. OHIO MEDICAID MANAGED CARE ORGANIZATIONS (MCOs) CONSOLIDATED RESOURCE GUIDE . Page 4 . To view this file, you may need to downloadAdobe Acrobat Reader. The OhioRISE Care Management Entity (CME) Manual provides guidance for OhioRISE . To stay up to date with all changes and updates to Ohio Medicaid's program, make sure to keep your contact information is up to date by contacting the Ohio Medicaid Consumer Hotline at (800) 324-8680. An Ohio.gov website belongs to an official government organization in the State of Ohio. These are titled Adding a Group Affiliation, Adding a Hospital Affiliation, and Affiliations.. Please click on this banner to be directed to the OhioRISE webpage. Learn everything you need to know to become a new Medicaid provider for the State of Ohio. . Read on if you are looking for information specific to our current programs. Ohio Department of Medicaid | 50 West Town Street, Suite 400, Columbus, Ohio 43215, Consumer Hotline: 800-324-8680 | Provider Integrated Helpdesk: 800-686-1516. Ohio Medicaid achieves its health care mission with the strong support and collaboration of our stakeholder partners - state health and human services agencies, associations, advocacy groups, and individuals who help us administer the program today and modernize it for the next generation of healthcare. An official website of the United States government This may include but is not limited to decisions involving prior authorization, inpatient review, level of care, discharge planning and retrospective review. Log in to the member portal to change your managed care plan. We continually update information, both on a periodic and an as-necessary basis, and the content in the manuals is subject to change without notice. For additional information, please visit: https://managedcare.medicaid.ohio.gov/providers. Have questions? Providers also will be able to verify recipient eligibility and update trading partner information. endstream endobj startxref Child Support Program. It guides how we operate our programs and how we regulate our providers. The changes we make will help you more easily access information, locate health care providers, and receive quality care. Heres how you know. Consumer Hotline: 800-324-8680 | Provider Integrated Helpdesk: 800-686-1516. The next generation of Ohio Medicaid managed care is designed to improve wellness and health outcomes, support providers in better patient care, increase transparency and accountability, improve care for children and adults with complex behavioral needs, and emphasize a personalized care experience. Remittance advices will note the recoupment, distinguishing it from the standard claims payments. |. Managed Care Procurement to social media. It guides how we operate our programs and how we regulate our providers. 2022-2023 Humana Healthy Horizons in Ohio Provider Manual - effective December 1, 2022, PDF. Workforce Development. Get Contracted by following the link below. We are streamlining provider enrollment and support services to make it easier for you to work with us. Effective Oct. 1, 2022, providers will utilize the new Provider Network Management Module (PNM) to access the MITS Portal. Prior Authorization Requirements to social media. Ohio Medicaid is changing the way we do business. Provider Manual. Provider billing and data exchange related instructions, policies, and resources. STATE PLAN SERVICES . On February 1, Ohio Medicaid launched the new electronic data interchange (EDI) and fiscal intermediary as part of our ongoing commitment to streamlining the provider administrative experience. . MEDICAID BEHAVIORAL HEALTH . Ohio Medicaid policy is developed at the federal and state level. We are committed to providing our stakeholders and partners with meaningful, reliable, and timely information to support evidence-based decision making and to drive program performance. The date of receipt is the date ODM assigns an internal control number (ICN). HM = Care Management Specialist - High School/Associate's This rule sets forth the Ohio department of medicaid (ODM) payment for hospice services and care. doctor, request an ID Card and more. As of Oct. 1, providers will utilize the new Provider Network Management (PNM) module to access the MITS Portal. Ohio Department of Medicaid | 50 West Town Street, Suite 400, Columbus, Ohio 43215, Consumer Hotline: 800-324-8680 | Provider Integrated Helpdesk: 800-686-1516, Department of Medicaid logo, return to home page. For insights into what you need to know, visit managedcare.medicaid.ohio.gov/providers. CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 10891 Date: July 20, 2021 Change Request 12177. . It is imperative that providers update all address and affiliation information in the PNM so that claims payments, provider directories, and network adequacy measurements are not negatively impacted. Provider billing and data exchange related instructions, policies, and resources. Click the "Download" button on this page to view the "2023 Ohio Medicaid Guidelines" resource. Ohio Department of Medicaid anticipates issuing the first payment of SFY 2024 to providers on July 7. Ohio Rise Medicaid UnitedHealthcare Connected 1. or Share sensitive information only on official, secure websites. (OAC Rule 5160119), Medicaid payment is paymentinfull. Ohio Medicaid will begin recouping advanced provider payments made October 14 that were offered due to connectivity issues between systems. On February 1, Ohio Medicaid launched the new electronic data interchange (EDI) and fiscal intermediary as part of our ongoing commitment to streamlining the provider administrative experience. Ohio resumed normal operations on February 1, 2023. MCG Care Guidelines licensed include: MCG and Anthems Medical Policies and Clinical UM Guidelines are available and can be requested by contacting Provider Services at 844-912-1226 or by emailing Anthem at Consumer Hotline: 800-324-8680 | Provider Integrated Helpdesk: 800-686-1516. Read on if you are looking for information specific to our current programs. We are redesigning our programs and services to focus on you and your family. Billing Manual Updates Version Description of Changes Last Editor Release Date Version 1.0 Final Version 1.0 State Policy Team 12.16.16 Version 1.0.a Added "HG" modifier to J8499 in Table 1-3 State Policy Team 12.23.16 . Published on March 18, 2021 . Hospice services: reimbursement. This page includes important information and links for vendors and others interested in working with Ohio Medicaid. Fee-for-Service pharmacy claims are . Electronic Visit Verification (EVV) is used by caregivers for some home and community based services to document the time services begin and end. The CMS Online Manual System is used by CMS program components, partners, contractors, and State Survey Agencies to administer CMS programs. Provider billing and data exchange related instructions, policies, and resources. On February 1, Ohio Medicaid launched the new electronic data interchange (EDI) and fiscal intermediary as part of our ongoing commitment to streamlining the provider administrative experience. OHIO MEDICAID Policy Name Policy Number Effective Date Obstetrical Care - Unbundled Cost PY-0004 08/01/2020 . Please see the Ohio Medicaid Opioid Treatment Program provider manual for specific billing instructions using office visit codes and J codes for medication administration. Ohio Department of Medicaid Provider Manual Page 2 of 42 Change Index: Date Published Date Effective Section(s) Updated Description of Change 5/31/2016 6/12/2016 1.1 Help Desk Telephone Numbers 1.2 Mailing Addresses 2.4 Required Data This page contains resources for the Ohio Medicaid provider community, including policy and advisory letters, billing guidance, Medicaid forms, research, and reports. The Ohio Department of Medicaid has many programs and initiatives to enhance the quality of care for patients and support our providers in the work they do each day. If you're asked to log in with an OHID - the state's best-of-breed digital identity - your privacy, data, and personal information are protected by all federal and state digital security guidelines. which time this manual will be incorporated into the broader Ohio Medicaid behavioral health provider manual. Through this link, providers can submit and adjust fee-for-service claims, prior authorization requests, hospice applications, and verify recipient eligibility. Episode-based payments is a part of quality-driven payment innovation programming in Ohio Medicaid. For insights into what you need to know, visit managedcare.medicaid.ohio.gov/providers. Click on the following links for step-by-step instructions on how to complete these actions. ODM has implemented a Unified Preferred Drug List (UPDL) to ensure quality patient care while maintaining a financially responsible program. Payments for claims may be subject to limitations and/or . Medical Policies and Clinical UM Guidelines, Screening, Brief Intervention, and Referral to Treatment, Early and Periodic Screening, Diagnostic and Treatment. Published on December 03, 2021 . NPI is the National Provider Identifier, a HIPAA requirement. Ohio Department of Medicaid | 50 West Town Street, Suite 400, Columbus, Ohio 43215. These systems include managed care entity (MCE) portals, the MITS page accessed via the PNM module, or through an authorized trading partner utilizing the new EDI portal. Ohio Department of Medicaid Provider Manual Page 2 of 57 7 Change Index: Date Published Date Effective Section(s) Updated Description of Change 5/31/2016 1.16/12/2016 Help Desk Telephone Numbers Electronic Visit Verification to social media. Press Tab or Shift+Tab to navigate through menu. A lock or https:// means you've safely connected to the .gov website. Proper billing and submission guidelines must be followed. Per Centers for Medicare & Medicaid Services (CMS), providers are NOT permitted to bill patients for missed appointments. Click herefor more information. In this Manual, many policies are described using the term "physician". Ohio Department of Medicaid COVID-19 and Mpox Resources and Guidelines for Providers. For additional information, please visit: https://managedcare.medicaid.ohio.gov/providers. If you're asked to log in with an OHID - the state's best-of-breed digital identity - your privacy, data, and personal information are protected by all federal and state digital security guidelines. An official State of Ohio site. Model agreement language for use by a nursing facility or intermediate care facility for individuals with intellectual developmental disabilities when closing or executing a change of operator. An Ohio.gov website belongs to an official government organization in the State of Ohio. AmeriHealth Caritas Ohio; Anthem Blue Cross Blue Shield; Buckeye Health Plan; CareSource; Humana Healthy Horizons Ohio; Molina HealthCare of Ohio Inc. UnitedHealthcare Community Plan; OhioRISE. It communicates policies and information about our programs. For our Advantage product line we pay providers from the ODM fee schedule. Learn about Ohio Medicaid'sNext Generation Managed Care Plans. Ohio Medicaid policy is developed at the federal and state level. ohiomedicaidprovider@anthem.com. NPI is the National Provider Identifier, a HIPAA requirement. All rights reserved. 2023copyright of Anthem Insurance Companies, Inc. Anthem Blue Cross and Blue Shield Medicaid is the trade name of Community Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. Contact the Integrated Helpdesk at 800-686-1516. Reimbursement relief for Medicaid billing providers and trading partners submitting claims via EDI. The Ohio Benefits website will enable Ohio residents to check eligibility and apply for a variety of benefits. Through this link, providers can submit and adjust fee-for-service claims, prior authorization requests, hospice applications, and verify recipient eligibility. Ohio Medicaid achieves its health care mission with the strong support and collaboration of our stakeholder partners - state health and human services agencies, associations, advocacy groups, and individuals who help us administer the program today and modernize it for the next generation of healthcare. The next generation of Ohio Medicaid managed care is designed to improve wellness and health outcomes, support providers in better patient care, increase transparency and accountability, improve care for children and adults with complex behavioral needs, and emphasize a personalized care experience. OhioRISE (Resilience through Integrated Systems and Excellence).
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