Attention providers in Ohio that participate in the state Medicaid program: a new electronic claims submission process is coming on February 1. Are you ready?

Claim.MD stands ready to help you with this significant transition. We’ve updated our connections to support the migration to Ohio Medicaid’s Next Generation program. This update will simplify the process of receiving ERA from multiple MCOs, while also accomplishing the states mandated requirements.
     
In Ohio, most Medicaid recipients are automatically enrolled for coverage through the managed care program. Shortly after enrollment, recipients choose from among approved Medicaid Managed Care Plans to receive care. The state has redesigned its Medicaid programs and services so recipients can more easily find providers, access information about their accounts, and receive care.

The Next Generation of Ohio Medicaid program is being implemented in phases to avoid confusion and reduce the burden on providers. The rollout began in July for youth behavioral services and those receiving coordinated care across multiple systems. Three months later, the state started requiring centralized provider credentialing and the Single Pharmacy Benefit Manager (SPBM) program for pharmacy services across managed care plans and members.

On February 1, the Ohio Department of Medicaid (ODM) will implement the new Electronic Data Interchange (EDI) module as part of the Next Generation program.  Regardless of whether enrollees are on Medicaid fee-for-service or in a managed care plan, all submissions will be processed through the OH Medicaid EDI system going forward. The state has issued new payer ID numbers in front of this change, and Claim.MD is currently in the process of testing this changeover with OH Medicaid to ensure that implementation goes smoothly for providers that use our software.

What this means to the providers is regardless of whether the member is receiving benefits through the Medicaid fee-for-service (FFS) program or enrolled in one of the Next Generation managed care plans, claims will be submitted to ODM.  

Here are the New Payer ID numbers that you will need to begin using on February 1, 2023.

Payer Name	Payer ID
United Healthcare Ohio Medicaid	88337
United Healthcare Ohio Vision Medicaid	83572
AmeriHealth Caritas Ohio	35374
AmeriHealth Caritas Ohio -Transportation Only	42435
Aetna OhioRISE	45221
CareSource OH Medicaid	00031
CareSource OH Vision	CSVIS
Buckeye Ohio Medicaid	00042
Buckeye Envolve Vision	V0042
Buckeye Access2Care	T0042
Molina Ohio Medicaid	00073
Molina March Vision	V0073
Molina Access2Care	T0073
Humana Ohio Medicaid	61103
Humana EyeMed	V0219
Humana Access2Care	T0219
Anthem Medical	A0029
Anthem EyeMed Vision	V0029
Anthem Access2Care Transportation	T0029

To continue receiving Electronic Remittance Advice (ERA) for the Ohio Medicaid Managed Care Plans, you must be enrolled for ERA under OH Medicaid (payer ID SKOH0). Providers who are already enrolled to receive ERA (835) with ODM do not need to re-enroll. Please note enrolling for ERA for OH Medicaid (payer ID SKOH0) will also setup ERA for the above listed Medicaid Managed Care Plans. There will be no change for MyCare claims which will continue to be submitted using the current process.

As a provider in Ohio, you can grumble about the EDI mandate and try to deal with it, or you can embrace the change and determine how to maximize the efficiencies and workflow of your practice to take advantage. Adopting more electronic practices can benefit your organization well beyond merely ticking a compliance box.

Claim.MD has a long history of making these types of transitions easier for our customers. We are experts in the field, using a straightforward process designed to get your claims paid as soon as possible. Additional information on the Next Generation Program can be found here: https://managedcare.medicaid.ohio.gov/providers