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January 19, 2023

Ohio Medicaid: Prepare for the Next Generation launch

What you can expect on Feb. 1, 2023

When the next phase of the Ohio Department of Medicaid (ODM) Next Generation Program launches on Feb. 1, the greatest impact to health care professionals will be to the new Electronic Data Interchange (EDI) and Fiscal Intermediary (FI). As ODM phases in these new system components, some of your day‐to‐day processes will change.

Claims and prior authorizations submitted through a trading partner

What’s changing on Feb. 1:

  • ODM’s new EDI will begin accepting trading partner fee‐for‐service (FFS) and managed care claims 
  • Claims submitted to trading partners must include the Medicaid member ID (MMIS)
    • Obtain a Medicaid ID with each encounter
    • Verify member eligibility using the ID through the Provider Network Management (PNM) module, which redirects to MITS
  • Professional claims can only include 1 rendering health care professional per claim. Please submit individual claims for services rendered by multiple health care professionals (There are exceptions for Federally Qualified Health Centers and Rural Health Clinics).

What’s not changing:

  • Continue to submit managed care prior authorizations to UnitedHealthcare using the existing processes
  • The new EDI will not accept prior authorizations of any kind

Claims and prior authorizations submitted through a portal

What’s changing on Feb. 1:

  • All Next Generation plans will have portals for direct data entry
  • The MMIS ID will be the identifying number used for FFS claims processing

What’s not changing:

  • Continue using UnitedHealthcare portals to direct data center claims and prior authorizations
  • Continue to access plan eligibility through the UnitedHealthcare provider portals

Questions?

Contact 800-600-9007.

PCA-1-22-04377-C&S-News_12292022
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