Ohio Medicaid Next Generation PNM New Features Implementation Scheduled June 30, MITS Module Sunsets

What You Need to Do If You’re Experiencing Billing Issues

OAMES met with the Ohio Department of Medicaid (ODM) this week and most of the meeting focused on the fast-approaching June 30 implementation of the new Ohio Medicaid Enterprise System (OMES) new features in the Provider Network Management (PNM) module. We’ve pulled together key information for members in this ebulletin to help minimize disruption post July 1 and offer guidance in the days and weeks ahead. 

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What you need to know for June 30:

• Key changes for providers - A two-page summary outlines the major changes affecting providers with the June 30 implementation and includes resources available to assist. The MITS system which has been a key “work-around” solution for providers will NO LONGER BE AVAILABLE. Click here for the "June 30 New Features Implementation FAQs".
• Upcoming planned system downtime – ODM will perform maintenance and system upgrades beginning at 5 pm on June 28 through 5 pm on June 30.  This will impact PNM and Fiscal Intermediary.  During the period, the PNM module will be unavailable, including direct data entered fee-for-service claims and prior authorization submission functions. Additional features, such as hospice enrollment and member eligibility look-up, will also be unavailable. For assistance, contact the ODM Integrated Helpdesk at 800‐686‐1516 or IHD@medicaid.ohio.gov. IHD reps are available 8 am -4:30 p.m. Eastern Monday-Friday.
• Review role assignments before June 30 – ODM urges providers to review PNM module role assignments before the new features are launched with the June 30 implementation. See full details and support information in the latest ODM Press bulletin.

OAMES has been raising concerns on numerous billing and claims processing issues affecting HME providers and sharing examples to help the agency identify and resolve problems over the past year.  Given the scope of this inter-agency change that’s affecting numerous Department staff, multiple vendors and all Medicaid providers, it has been a daunting task.

With the imminent launch of the OMES features and full implementation of PNM, it is vital that specific steps be taken to ensure communications are as efficient and effective as possible.  ODM is urging all healthcare providers, including OAMES members, to report their billing issues through the ODM Integrated Helpdesk to avoid redundancies, excessive emails and disjointed communications so that all issues are identified, tracked and resolved by the agency and their vendors with minimal disruption.

OAMES only recently learned of the Department’s Comprehensive Payment Systems Error (CPSE) report which is the key document to guide these efforts going forward.  The report is updated on the first Tuesday of each month to publicly provide healthcare providers with a list of known issues (“defects”) and share the progress of their resolution.  Click here for the June report which includes the current status of issues with provider description, percentage completed and provider type.

What you should do if your company is experiencing PNM billing issues:

• Identify if your issue is a “known” issue – Review the provider “description” and “type” columns in the CPSE report posted here to see if the issue your company is experiencing is listed which means it’s already reported by other providers. If it is listed in the report, it’s considered a “defect” and ODM is working with vendors to resolve it; no reporting action is needed on your part.
• How to report your issue if not on CPSE report – If you’ve reviewed the latest CPSE report and your issue(s) is not listed or you’re not sure, contact the ODM Integrated Helpdesk (IHD) at 800-686-1516 to add it. Issues reported through the IHD are documented, a ticket number assigned and tracked by ODM.
• Provide ICN number when submitting an issue – You MUST provide ICN number(s) for ODM to have the details they need to internally review and trouble-shoot your specific problem. A general “it’s not working” response won’t suffice.
• Contact ODM Helpdesk, not ODM Policy – Please contact the ODM Integrated Helpdesk staff and not the Non-Institutional Policy team for any PNM-related issue. Policy staff do not have the capability to assist with PNM issues; they MUST go through the IHD. 
• Track progress on issue resolution – There are three ways to track whether a reported issue has been resolved: 1) Check the monthly CPSE report (we recognize it’s only monthly but it’s the most comprehensive PNM tracking tool available); 2) Call the Helpdesk, IHD representatives can provide updates on issue resolution status; and 3) Review your remittance notices thoroughly for updates.
• How will you know when issues are resolved – ODM has indicated that mass adjustments will be made for any issues that are resolved. You need to watch your remittance notices and review for progress; no further action is needed on your part. 

OAMES will be monitoring the PNM implementation and continue to share any further guidance and developments with members via OAMES ebulletins.