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October 11, 2023 at 5:00 AM CT

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.

Get the details

Electronic visit verification (EVV)

Information applies to: Private duty nursing, home health aide, home health nursing, RN assessment, waiver nursing, waiver personal care aide and waiver home care attendant

The 21st Century Cures Act requires state Medicaid plans to implement an EVV system for home and community-based services (HCBS).  

Electronic Visit Verification and claims 

  • Failure to use the EVV platform may result in claim denial
  • It's important to ensure the details of the visit match the claim details
  • We’ll quickly review your application – and if we’re not accepting new applications for your area or specialty, we’ll let you know.

Your responsibility with EVV

  • Ensure visit details are accurate
    • Document when the visit begins and ends
    • Select the correct fields:
      • Payer is UnitedHealthcare
      • Billing provider: Provider ID and provider type (agency, IP)
      • Individual: Client ID and name
      • Service provided
      • Date of service
      • Number of units
  • Edit visit details if needed
  • Ensure visit is in “Verified Status” before billing the service

Warning
Once you submit your claim, check for claim remittance advice remark code (RARC) N363: “Alert: in the near future, we are implementing new policies/procedures that would affect this determination”. If there is no match, we will deny your claims in the future.

Training

Visit the Ohio Department of Medicaid website to find educational opportunities such as past webinars, schedule a help session or read Frequently asked questions (FAQ) and EVV newsletters. You must complete EVV training to access the EVV system.

Additional resources

Questions?

Go to the Ohio Department of Medicaid website contact information page or email EVV@medicaid.ohio.gov.