This past month, the managed care plans have published updates on events and policy changes impacting their organizations.
Ohio Department of Medicaid:
The Ohio Department of Medicaid, in partnership with Maximus, the Provider Network Management (PNM) module vendor, is excited to share that they are continuing their provider awareness and training efforts by offering a “Provider Network Management Module” refresher training. Training is scheduled for November 12-22, and the training schedule is available on the PNM and Centralized Credentialing page. To learn more, click here.
The Ohio Department of Medicaid (ODM), with the understanding that providers have experienced issues with the Electronic Data Interchange (EDI), is extending the exception to timely filing requirements by two months. They will consider EDI claims that are older than 365 days with a date of service or inpatient discharge date of January 25, 2022, or after, timely if submitted before December 1, 2024. They will deny any claims older than 365 days submitted after this date.
Open enrollment period will run from Nov. 1, 2024 – Nov. 30, 2024. During this time, members are able to select their plan (effective Jan. 1, 2025) by calling the Ohio Consumer Hotline at (800) 324-8680 or by visiting members.ohiomh.com/Login.aspx.
AmeriHealth Caritas:
As part of the AmeriHealth Caritas Appian deployment to connect Appian and the Prior Authorization lookup tool, there is a new message in the tool that will notify users when a code is not on ODM’s fee schedule. Click here to learn more.
Buckeye Health:
Buckeye Health is reminding providers that flu season is right around the corner, and it’s time for everyone to get up to date on vaccinations. With your patient’s trust and their best interest at heart, it’s up to you to recommend they get their flu vaccine. Click here to learn more.
CareSource:
CareSource has published updates regarding the JZ and JW modifiers in regard to single dose vial drug claims. To learn more, click here.
Humana Healthy Horizons:
Lists of services and medications effective Jan. 1, 2025, that may require preauthorization for patients with Medicaid coverage are now available here.
Molina Healthcare:
Molina is offering the chance to enter a monthly drawing for a prize! To enter, join a provider training and share your name and email. Click here to learn more.