Ohio Medicaid Announces Delay in Launch of Fiscal Intermediary & New Managed Care Plans
Many OOS members have been impacted by recent changes in the Medicaid program announced earlier this year. While the Ohio Department of Medicaid (ODM) has moved forward with implementation of OhioRISE, Single Pharmacy Benefit Manager (SPBM) and Centralized Credentialing, there are now delays in other transitions originally scheduled to take place on Dec. 1 that impact how claims are filed and new managed care companies.
ODM made the following announcement earlier this week:
Based on the feedback we have received and our commitment to carefully transitioning, we will not implement the new Next Generation managed care plans and the full Ohio Medicaid Enterprise System (OMES) launch on December 1. The new lineup for implementation is as follows:
- On February 1, 2023, ODM will launch the Next Generation managed care plans and program requirements, including exciting improvements that will support members in accessing the healthcare services and supports they need. ODM will also implement the new Electronic Data Interchange (EDI), increasing transparency and visibility of member care and services.
- Subsequently, ODM will fully launch OMES modules to provide streamlined processes for claims, prior authorizations, and other administrative tasks for providers.
Providers should continue conducting business as you do today on and after December 1 – including the processes, procedures and systems used today to submit claims, prior authorizations and complete other administrative functions. ODM will provide more information about the upcoming implementation for members and providers in the coming weeks.
Thank you for your continued partnership and support of the Next Generation Ohio Medicaid program!
Please reach out to the Next Generation mailbox with questions. Thank you for your continued partnership and support of the Next Generation Ohio Medicaid program!