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November 30, 2023
December 2023 Managed Care Plan Updates

This past month, the managed care plans have published updates on events and policy changes impacting their organizations.

Molina Updates:

Molina has made enhancements to their claim reconsideration (non-clinical claim dispute) process: Staff members will work towards First Call Resolution during this enhanced process, while guiding the claim through the resolution paths below:

  1. Corrected Claim (claim submission error): Molina will provide information as to the missing or mis-entered field on the claim submission.
  2. Fast track (New): The Provider Contact Center agents will perform live adjustments during the call.
  3. Claim Reconsideration (Non-Clinical Claim Dispute): The request will be researched, and if a processing issue is identified, the claim will be re-adjudicated, and an updated remittance will be provided.

To learn more about these enhancements, please contact OHProviderRelationsPhysician@MolinaHealthcare.com.

Ohio Department of Medicaid Updates:

If you are a Medicaid provider and currently due for a revalidation in the Provider Network Management (PNM) module, please take immediate action to complete and submit your revalidation application to renew your Ohio Medicaid Provider Agreement. ODM will begin terminating providers who fail to complete their revalidation prior to their specified deadline, starting January 23, 2024.

How do you know if you are due for revalidation?

  1. Check your mail and email. An email would be sent from OHPNM@maximus.com.
  2. View the Correspondence folder in the PNM module by selecting “Enrollment Notices” as the type of correspondence and searching for the “Revalidation Notices.”

For technical support or assistance, contact Ohio Medicaid’s Integrated Help Desk at (800) 686-1516 and follow prompts for Provider Enrollment (option two, option two) or email IHD@medicaid.ohio.gov. Representatives are available Monday thru Friday, 8 a.m. through 4:30 p.m. ET.

 

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