As the Ohio Department of Medicaid transitions to the Next Generation of Ohio Medicaid, there have been some issues for healthcare providers. In particular, there have been challenges in the transition from MITS (Medicaid Information Technology System) to the PNM (Provider Network Management) module.
Advanced Billing & Consulting Services (ABCS RCM) has worked with Ohio Medicaid regulations and behavioral health reimbursements for many years. We understand that this is a complex process that can create disruptions in a medical clinic’s daily operations and overall cash flow.
Back in 2019, the ODM (Ohio Department of Medicaid) started their Medicaid managed care procurement process. A primary objective for transitioning to the Next Generation Ohio Medicaid program was to place an increased emphasis on cross-agency coordination. This includes a partnership with other state agencies, managed care organizations (MCO) and Medicaid vendors.
As ODM updates their systems, disruptions in claims processing, payments and administrative tasks have occurred. However, as some long-time industry observers have likely noticed, similar events happened in the past when Medicaid computerized systems were updated. Keeping this in mind, helps add some context to these current problems.
From MMIS to MITS to PNM:
A major step in this transition was the implementation of a new Medicaid provider portal and enrollment system. Medicaid Information Technology System (MITS) has been a standard part of the Ohio Medicaid system for many years. Yet, before there was MITS, Ohio Medicaid previously used a system called MMIS (Medicaid Management Information System).
In 2004, the state of Ohio was approved by the Centers for Medicare and Medicaid Services (CMS) to launch a new Medicaid Information Technology Architecture. MITS developed out of this modernization drive. The system was built to respond to the technological demands of the state’s health care marketplace. MITS was intended to help Medicaid consumers, managed care plans and fee-for-service providers.
However, in 2011, the launch of MITS was not as trouble free as had been expected. Patients, providers and vendors soon experienced problems with the new MITS system. There were delayed reimbursements, service disruptions and missing medical information.
Ohio Medicaid did fix these issues and overtime Ohioans became comfortable with using MITS. Now over a decade later, Ohio is once again updating their Medicaid system. The launch of the new Provider Network Management module has created a little déjà vu in the Ohio Medicaid provider community.
Next Generation – Transitioning from MITS to PNM:
Ohio Medicaid is converting the MITS Provider Enrollment System to the new Ohio Medicaid Enterprise System (OMES). The new OMES includes a new portal/interface for the Provider Network Management (PNM) module. However, the rollout of the new Medicaid system has not been without its challenges.
Since the October 1, 2022, launch of the new Provider Network Management module, some Ohio providers have experienced intermittent access disruptions to needed systems as well as delayed reimbursements for services rendered. These disruptions include claim denials and the rejection of new provider roster updates.
The ODM staff are actively working with the impacted customers and billing agencies in order to remedy these problems. They are aggressively working on these system issues, prioritizing those most likely to impact provider claims and individual care.
Some Ohio healthcare associations have stated that ODM is experiencing programing and interface issues with both MITS and PNM. ODM has called this part of the Next Generation rollout Phase 2, with Phase 3 scheduled for implementation on February 1, 2023.
Healthcare providers should prepare by prioritizing and addressing any phase 2 issues that they are experiencing as soon as possible. There is a significant chance that the Phase 3 implementation will create new access and reimbursement problems that will also require attention. Providers should free up as many possible resources as possible in case they also experience issues with the new Phase 3 rollout.
Impact on Providers and Claim Payments:
We are an Ohio-based medical billing company that works with a variety of healthcare agencies, medical practices and insurance payers. One of our revenue cycle management specialties is community behavioral health centers and psychiatry practices.
Due to this experience, we understand that medical reimbursements, roster updates and credentialing is actually a complex process with many moving parts. We are sympathetic to the problems that Ohio providers are experiencing and understand their frustration. We have been assured that ODM is working quickly in order to address and remedy any issues.
Years ago, the adoption of the Ohio MITS took time. There were programing, security and interface issues. It is not surprising that a similar situation is occurring with the rollout of the new Ohio Medicaid Enterprise System (OMES) and the Provider Network Management (PNM) module.
General advice for Ohio providers who are participating in the Ohio Medicaid Enterprise System:
- Providers should be prepared for potential delays in the ODM’s Next Generation system.
- Inability to update provider profiles and their affiliations (rosters) will likely create claim denials.
- Healthcare providers who are just starting in the Ohio Medicaid system will most likely experience a longer enrollment process. This means that their reimbursements are also likely delayed.
Having the ability to update rosters in PNM is essential. This is where clinics and practices need to both remove inactive providers as well as add new providers. Otherwise, a new provider is not classified as a servicing provider by the state of Ohio Medicaid system. In these cases, any claim submitted by them is not recognized.
What are Some of the Major Changes on February 1, 2023:
This information is current as of the date of this article’s publication.
What can Ohio providers expect:
- During the February 1 launch, the new EDI and FI could impact some providers.
- As these new system components are adopted, some of the day-to-day processes will change. However, other processes will remain the same.
- All Next Generation plans will have portals for direct data entry.
- MMIS ID will be the identifying number used for FFS claims processing.
- Continue using managed care plan portals to direct enter claims and PAs.
- Plan eligibility will continue to be accessed through MCO portals.
- Continue using the PNM module, which redirects to MITS, as you do today to submit, adjust, and search FFS claim and PA information.
Practices and agencies should directly contact Ohio Medicaid for the most up-to-date information. For your convenience, please use the following information to access ODM information & resources:
Provider Network Management Information: https://medicaid.ohio.gov/resources-for-providers/nextgeneration-pnm
Provider Network Management Portal Login: https://ohpnm.omes.maximus.com/OH_PNM_PROD/Account/Login.aspx
ODM’s Integrated Help Desk phone number: 1-800-686-1516
- PNM Assistance/Error Message: Select Option 2 followed by Option 3.
- Ohio Medicaid Enrollment/Credentialing Questions: Select Option 2 followed by Option 3.
About ABCS RCM:
Advanced Billing & Consulting Services provides billing and patient statement solutions for healthcare practitioners. Their services include medical billing, insurance enrollment/credentialing monitoring services for clinics, practices and agencies.
ABCS also provides staff management and EVV tools as well as billing services for agencies that provide supports for the Ohio I-DD community.
To learn more, email or call them at 614-890-9822 or 866-460-2455.
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