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Latest News

UPDATE! State Fiscal Year-End Claims Submission and Provider Payments

Medicaid provider claims submitted after 12 p.m., Friday, June 21, will be held for processing until Ohio Administrative Knowledge System (OAKS), the state’s accounting system, is up and running for state fiscal year (SFY) 2025, beginning July 1.

The Ohio Department of Medicaid anticipates issuing final provider payments for SFY 2024 on Thursday, June 27. For SFY 2025, fiscal year-end processing may cause a delay in payment until OAKS is up and running. The Ohio Department of Medicaid anticipates issuing the first payment of SFY 2025 to providers on July 8.

Please note, due to fiscal year-end processing and the July 4 holiday, OAKS processing may experience a brief delay and payments may not be made on July 8, as anticipated.

PERM RY2025 Update

The Payment Error Rate Measurement (PERM) 2025 Audit is in progress. If chosen, providers will receive a medical records request from the CMS review contractor, Empower AI. Please be advised that sampled providers who fail to cooperate may be subject to payment recovery by Ohio Medicaid Program Integrity. For more information on PERM visit: https://medicaid.ohio.gov/news.

Next Generation of Ohio Medicaid is implementing new OMES features! Here is what you need to know.

The Ohio Department of Medicaid (ODM) continues to implement new initiatives and improvements to achieve the program’s mission to focus on the individual and improve the provider experience. As an extension of this effort, we will implement new features in Ohio Medicaid Enterprise System (OMES) modules. Providers will see and utilize these new features in the Provider Network Management (PNM) module beginning on June 30, 2024. To learn more about the benefits providers and other PNM users will experience please read our implementation announcement.

IMPORTANT REVALIDATIONS UPDATE: 

If you are currently due for a revalidation in the Provider Network Management (PNM) module, it is imperative that you take immediate action to complete and submit your revalidation application to renew your Ohio Medicaid Provider Agreement. ODM will begin terminating providers who fail to complete their revalidation prior to their specified deadline, starting May 1.  

Specialties Reminder

 

It is imperative that the Specialties page in the Provider Network Management module is accurate. This information is used for provider directories and sent to the managed care entities. For further details, view the ODM Press article.

 

Fee Schedules

You can access Ohio Department of Medicaid fee schedules on the Schedules and Rates page of the Ohio Medicaid website. You can also access them via the PNM home page, by clicking on the “Fee Schedule” tab and following the prompt to the hyperlink. Note: you do not need to be logged into PNM to access the “Fee Schedule” tab.

Ohio Department of Medicaid Rate Increases

Ohio Department of Medicaid (ODM) is pleased to announce the rollout of reimbursement rate increases, totaling $3.4 billion per year, effective January 1, 2024. This investment demonstrates Governor DeWine's commitment to support providers as they continue delivering the highest level of care for Ohio’s residents.

To learn more about the provider rate increases, including rate trackers and frequently asked questions, visit the ODM budget webpage on the Ohio Medicaid website. For additional assistance, providers can contact the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov. Representatives are available 8 a.m.-4:30 p.m. Eastern time, Monday – Friday.

 

Important: Revalidations Update

 

If you are currently due for a revalidation in the Provider Network Management (PNM) module, it is imperative that you take immediate action to complete and submit your revalidation application to renew your Ohio Medicaid Provider Agreement. ODM will begin terminating providers who fail to complete their revalidation prior to their specified deadline, starting January 23, 2024. For further details, view the ODM Press article.

 

New ODM10304 form for PNM Admin transfers

Ohio Department of Medicaid (ODM) developed a new form, ODM10304, that must accompany specific requests to change Provider Network Management (PNM) Administrators across organizations. Please review the ODM Press article for further detail and exceptions.
 
PNM learning resources

Click the "Learning" tab in the top menu of the PNM application to access user guides and quick reference guides. Note: You do not need to be logged in to access this menu.

Disenrollment Quick Reference Guide is available

The Provider Network Management (PNM) Disenrollment Quick Reference Guide offers step-by-step instructions on disenrolling a provider from Ohio Medicaid within the PNM module. These steps should only be completed if you wish to request the withdrawal of a provider’s enrollment with Ohio Medicaid. Once completed, the Medicaid ID assigned to that provider will no longer be active.

Reminder: Update addresses and affiliations in the Provider Network Management (PNM) module

 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. Click on the following links for step-by-step instructions on how to complete these actions.

 
Incomplete PNM affiliation steps may impact provider billing

Through a series of PNM queries, Ohio Department of Medicaid (ODM) has identified several affiliation issues that impact billing organizations claims. It is imperative that providers fully execute all steps when affiliating a rendering provider to their group/organization/hospital to avoid claims payment issues. An Affiliations Quick Reference Guide (QRG) has been created, showing step-by-step instructions and information related to entering an affiliation as a new individual practitioner; confirming, adding, and removing an individual practitioner’s affiliation as a group or organization.

 
Integrated Helpdesk support hours

For technical support or assistance, contact the IHD at 800-686-1516 or IHD@medicaid.ohio.gov. Representatives are available 8 a.m.-4:30 p.m. (EST) Monday-Friday.

Additionally, the Interactive Voice Response System (IVR) provides 24/7 access to information regarding client eligibility, claim and payment status, and provider information.

Why use OH|ID?

When creating a new account, you will be required to create an OH|ID. OH|ID is a secure web portal designed for Ohioans to access information and conduct business with a variety of state agencies, including Medicaid, all in one place. Visit https://ohid.ohio.gov/wps/portal/gov/ohid/help-center to learn more about OH|ID and available support options.

ODM trading partners

Visit the trading partner webpage for Medicaid claims reimbursement information.