This past month, the managed care plans have published updates on events and policy changes impacting their organizations.
- ODM EDI Claims and Bridge Payments for Providers: CareSource has updated that as part of the Next Generation program transition, ODM developed extensive monitoring and a variety of contingency plans. Specifically, Ohio Medicaid is now initiating extra measures to minimize provider disruption and ensure payment continuity. ODM is also providing an opportunity for certain billing providers to opt-in to be considered to receive temporary bridge payments due to delays in processing claims through ODM and MCE IT systems. To be considered for a bridge payment, provider must (1) “opt-in” by providing information to ODM. Click here to read more about this update.
Buckeye Health Plan Update:
- Direct Submission of Claims by Trading Partners: Buckeye has updated that based on recent tends with successful transmission rates, ODM has determined the direct submission of claims by trading partners to MCEs is no longer needed and would create an inconsistent provider experience across MCEs. As a result, ODM is not approving any trading partner to submit EDI claims directly to the MCEs. Fee-for-service (FFS) and managed care EDI claims should continue to be submitted directly to the OMES EDI vendor, Deloitte. Click here to read the full update.