Avoid claim denials – make your PNM updates before Oct. 20, 2023
Effective Oct. 20, 2023, Next Generation Medicaid managed care organizations (MCOs), the OhioRISE plan and MyCare Ohio plans must use provider data from Ohio Medicaid’s Provider Network Management (PNM) module as the official system of record. Health care professionals must keep their records updated within the PNM module. If your data in the PNM module does not match the data on your submitted claims, your claims will be denied for payment.
Cardiology Prior Authorization and Notification Program
The cardiology prior authorization and notification programs support the consistent use of evidence-based, professional guidelines for cardiology procedures. They were designed with the help of physician advisory groups to encourage appropriate and rational use of cardiology services. Using them helps reduce risks to patients and improves the quality, safety and appropriate use of cardiac procedures.
Using Electronic Data Interchange (EDI) for all eligible UnitedHealthcare transactions can help your organization improve efficiency, reduce costs and increase cash flow. We encourage you to use the following tools and resources to get started with electronic transactions.
Oncology Prior Authorization and Notification Program
The oncology prior authorization and notification programs aim to increase quality and patient safety by increasing compliance with evidence-based standards of care. View the following link for more information and resources on the specific programs.
Radiology Prior Authorization and Notification Program
The radiology prior authorization and notification programs support the consistent use of evidence-based, professional guidelines for diagnostic imaging procedures. They help reduce risks to patients and improve the quality, safety and appropriate use of imaging procedures.