Fee-For-Service Claims Not Visible in the Provider Network Management Module

The Ohio Department of Medicaid (ODM) has identified an ongoing issue with fee-for-service (FFS) claims. The impacted claims are submitted through the Provider Network Management (PNM) module to be processed and adjudicated by the Fiscal Intermediary (FI). However, this issue is preventing some FFS claims from being retrievable in the PMN module, resulting in unpaid or unadjudicated claims.

How do providers know if their claims are affected?

If a provider submits an FFS claim via the PNM module and that claim cannot be found in a subsequent search, the claim is impacted. These claims will not generate a remittance advice and ODM will not have paid them. This issue may occur intermittently for any provider type.    

What is ODM doing to fix this issue?

ODM and its vendors are actively taking steps to resolve this issue. An update to the FI scheduled for September 11 will significantly reduce the frequency of and impact to claims. The PNM and FI will implement additional updates on October 8 that will largely eliminate the issue.

What actions do providers need to take?

If providers submitted an FFS claim via the PNM module but cannot retrieve it in a claims search or find its remittance advice, please resubmit. If this issue occurs after October 8, please contact the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov. Representatives are available 8 a.m.-4:30 p.m. Eastern time, Monday - Friday.

We understand the inconvenience this issue creates and appreciate your patience as we work on the resolution.