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.
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
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.
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.