07/15/2024

Ohio Medicaid Announces Lifting PA Requirements Due to PNM Module Issues

The Ohio Department of Medicaid (ODM) announced that they are lifting prior authorization (PA) requirements for fee-for-service claims that would require a PA with service dates as of 6/30/24, due to submission issues in the Provider Network Management (PNM) module. 

This was communicated to the provider community in an email announcement last Thursday and ODM Press on Friday.  Numerous PA issues have been reported to the OAMES office by members since the June 30 PNM update.  Members have been advised to share these issues (and any others) with the ODM Integrated Helpdesk to allow the Department to track the nature and volume of the problems providers are experiencing in the PNM module. 

OAMES confirmed with ODM Non-Institutional Policy staff that this PA change applies to all Medicaid covered services including DMEPOS, which raises operational and processing implications for OAMES members.  We’ll be discussing these concerns at our next regularly scheduled meeting with ODM on Tuesday, 7/16/24, and continue communications on this important change going forward.  As we learn more, we’ll provide updates to OAMES members. 

All healthcare providers serving Medicaid recipients who are experiencing any PNM issues are urged to continue reporting them to the ODM Integrated Helpdesk by phone at 800-686-1516 or via email at IHD@medicaid.ohio.gov so that the agency can identify, track and resolve PNM system issues at a central point of contact. You should also subscribe to the ODM Press if you aren't already to receive updates about the PNM module and other important news for the Medicaid provider community.