12/07/2023

ODM Answers NF Provider Questions

In its monthly meeting with LeadingAge Ohio, the Ohio Department of Medicaid (ODM) answered numerous questions posed by NF members. Below are the complete Q&As from the meeting. 

During an OHCA billing summit, members from ODM indicated that providers could create a workbook of recoupments that they are unable to post from PNM and send to a designated email for research.  Associations have yet to receive this email address and are told that current remits do contain the information needed moving forward.  However, the old remittance advice with recoupments still need to be researched. Is there any updates from ticket submissions to the IHD to research these recoupment amounts?

 

• The Ohio Department of Medicaid is looking into this issue, as there is conflicting information being shared with providers. In the past, ODM suggested providers pull together an Excel spreadsheet of recoupment issues and email the spreadsheet to ODM instead of creating individual tickets. ODM Staff on the call were unaware this guidance was provided and will follow-up with provider associations with correct information. The issue is becoming an emergency due to balancing financials at the end of the year. Providers need a patient name or claim number on their remittance advices so they can post proper payments to their accounts.
  

Associations are continuing to receive reports of auto-adjustments removing patient liability deductions.  The most recent example is all claims for August and September for NPI 1285785568.  Why is this occurring and how can providers obtain corrections on these claims without a claims portal?

 

• When claims are adjusted there is an issue that removes the patient liability. ODM is aware of this issue and is in the process of fixing this issue, and once the issue is fixed, ODM will be able to reprocess and recoup claims. Recoupments will occur in January of 2024 and providers will not need to do anything. Additionally, ODM is working on a development testing timeline, which will likely be provided in January.

Do you have an update on the claims portal?

 

• ODM does not have an update on when the P&M portal will interface with the FI. The Department will need to train providers once the claims portal is finished, which will take about 6-8 weeks after providers are notified. The training will include hospice providers. The P&M claims portal will change to FI, except for hospice, which will go to MITS and then FI.
  

Associations continue to hear that vent claims are not reprocessed at the correct rates since July of 2023.  It was reported several months ago that this was resolved.  

 

• ODM has made several changes for vent claims and has identified issues, which are currently being reviewed by the Department for appropriate codes. It will take ODM 2-3 weeks to review claims and any missed claims will be reprocessed.

Associations have received many requests from providers that ODM develop a complaint portal for FFS claims, similar to the existing complaint portal for managed care claims, so that issues can be better tracked and reported.  Is this something the Department can create?

 

• ODM is working on building out FFS claims issues that have been occurring on the FI side and do not believe there are outstanding issues on the MITS side. It appears, however, the provider type is the main instigator. ODM needs a little more time to share information, which will likely occur in a few weeks. Associations shared that providers no longer want to provide tickets because they do not receive a response from ODM. Providers are requesting a provider complaint portal or drop-down for FFS, like the managed care complaint portal (Provider Complaint Form (ohiomh.com)). ODM will take this information back to colleagues to see what can be done, however, ODM is working on making sure providers receive responses because it is important to know what issues there are and how the data can be tracked. ODM would like to re-enforce that providers should use the ODM Help Desk, as the Department holds multiple weekly meetings to identify issues and outstanding tickets.

Is there any new information on the Medicare crossover claims issues?

 

• ODM has received specific claims information from providers and is reviewing the information. The Department will share the findings at a later date, however, they can share that changes are in process to maximize acceptance of crossover claims. ODM will have more to share over the next few weeks and they would like to encourage providers to continue to use the integrated Help Desk.
  

Will ODM extend filings? Providers are concerned about running up to 12 months timely filing deadlines.

 

• Conversations have taken place at ODM and Gainwell is currently looking into this. ODM will provide an update soon.