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Ohio Medicaid: MITS, Managed Care Update

MITS Update

OPA Executive Director Ernie Boyd and OPA Director of Government Affairs Kelly Vyzral met with Ohio Medicaid Director John McCarthy and several members of his staff for over an hour yesterday. The meeting was very helpful and we did learn the answer to several questions concerning MITS.

Here is what is going on:

This week's payment includes drug claims adjudicated by pharmacies to a paid status on July 16 through July 26. Claims processed to a paid status on July 27 through August 5 should appear on your payment next week. MITS is still having trouble processing reversed and adjusted claims. As a result, these will be processed on a future date. In the meantime, payments will be made for original claims only: claims that have not been adjusted or reversed after the original payment. This may cause your payments to be slightly higher for a few weeks. As MITS works to resolve this issue, they will continue to provide updates. In addition, MITS has received a few compound claims with ingredients not recognized by the system (for example, an NDC was entered using the UPC for distilled water). As a result, these will not appear on your payment. Medicaid has assured us they are working to resolve this issue, as well.

Please let us know if you continue to have problems with MITS and your payments. If you have any questions or concerns, please e-mail Kelly at kvyzral@ohiopharmacists.org.

Medicaid Managed Care Update

We know that many of you have questions about the switch over to managed care. We brought your concerns about the switch to managed care to the Director and had a very long discussion about this subject. Director McCarthy has assured us that the State will be taking a bigger role in the way the managed care companies operate within the Medicaid program and that pharmacies should continue to communicate with OPA about issues or questions that they have. Director McCarthy will be contacting the managed care companies and asking them to communicate with the pharmacies about the upcoming switch over and to let the pharmacies know of any steps that need to be taken to assure their participation in the Medicaid program. If your pharmacy participated in the Medicaid program when it was previously under managed care, those contracts are still valid, and you will be working with the same companies you worked with before.

As we receive more information from the Medicaid Department, we will of course get it out to you as soon as possible.


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