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

Molina Update: 

• Process for Submitting EDI Inquiries to Molina: Molina has received questions from providers and their Electronic Data Interchange (EDI) Clearinghouses/Trading Partners (TP) regarding the Ohio Department of Medicaid (ODM) Ohio Medicaid Enterprise System (OMES) EDI file submissions and response files. The information linked here outlines the steps to take so Molina can thoroughly research and advise on the next steps. Molina requests that our providers also share this information directly with their EDI partners.
• Psychiatric Diagnostic Evaluation Limitations: Effective July 1, 2023, claims billed for procedure codes 90791-90792 and G0396-G0397 with an HE modifier will be denied if received more than once in a calendar year per billing provider. Procedure code H0001 with a modifier HE is restricted to two submissions per calendar year per billing provider. Claims submitted exceeding the frequency limit will be denied. Click here and scroll to the bottom of page 2 to learn more.
• Review Your Molina Medicaid Member’s Renewal Date in Availity: Perform individual Eligibility verifications in Availity. Results will show a redetermination date for any member upcoming in the next 60 days in scenarios where the member needs to take action.  Click here and scroll to the top of page 3 to learn more about this tool.