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Important Notices & Updates

Claims submitted after 12:00 p.m. on Friday, June 24,, will be held for processing until the Ohio Administrative Knowledge System (OAKS), the state’s accounting system, is up and running for state fiscal year (SFY) 2023 (beginning July 1). The Ohio Department of Medicaid anticipates issuing final provider payments for SFY 2022 on Wednesday, June 29, however, fiscal year-end processing may cause a delay in payment until OAKS is up and running for SFY 2023. The Ohio Department of Medicaid anticipates issuing the first payment of SFY 2023 to providers on July 8. Please note, as a result of fiscal year-end processing and the July 4 holiday, OAKS processing may experience a brief delay and payment may not be made until the week of July 11.

Due to the recent Abbott infant formula recall and related formula shortages, the ODH WIC Program is temporarily allowing several flexibilities, including more formula options (brands and container sizes) for standard milk and soy-based infant formulas. Additionally, the Ohio WIC Program is temporarily allowing the issuance of store brand hypoallergenic infant formulas.

See the notices:

Ohio WIC Prescribed Formula Letter (PDF)

WIC Food Request Form (PDF)

Beginning May 1, 2022, inpatient stays of less than 48 hours may be converted to an observation status unless one of the exceptions listed within Clinical Policy: Short Inpatient Hospital Stay are met. You will find a copy of the policy in the Clinical and Payment Policies section of Provider Resources.  The Short Inpatient Hospital Stay policy is applicable to Medicare (Wellcare By Allwell) and Marketplace (Ambetter) lines of business.

Posted January 24, 2022

Ohio Department of Medicaid Now Requires Medicaid ID Number

What’s Happening:

Compliance with new federal rules 42 CFR 438.602.

 

The Ohio Department of Medicaid (ODM) currently requires any provider that submits a claim for a Medicaid patient to be enrolled with ODM and have a Medicaid ID number.  The provider must be enrolled on the date of service billed.

Effective March 1, 2022, Buckeye Health Plan will be enforcing this ODM requirement for claims received on or after March 1, 2022.  Providers will be required to have an active Medicaid ID on file with Buckeye Health Plan for all claims, regardless of the date of service.

How to Apply for or Revalidate a Medicaid ID number:

For Providers without an active Medicaid ID number or need to revalidate their Medicaid number, follow the steps below to apply for a new Ohio Medicaid number

  1. Go to the MITS Portal at: Providers (ohmits.com)
  2. Select “Provider Enrollment Application”,
  3.  Select the “I need to enroll as a provider to bill Ohio Medicaid option.
  4. Follow the system prompts and provide the requested information.
  5. When you have completed all steps, please submit your application.

You can view the status of your application online by visiting the following link: Enrollment Tracking Search (ohmits.com).  You will need to provide your Application Tracking Number (ATN) and name used to complete the application to check the application status.

To contact ODM, please call 800-686-1516.

What do I do next?

Nothing. Once you have received your Medicaid ID number, it will automatically update in our system when you submit a claim. If you have questions, please contact Provider Services at 1-866-296-8731.

For your reference:

Recently, you may have received a letter from Buckeye re: the 2019 Episodes of Care Results and outstanding 2018 negative incentive amounts.

Due to a system error, the breakdown by episodes were mis-labeled. We want to assure you that this issue was with the way the episodes were labeled, not with the total incentive. The total incentive indicated on the letter is correct.

If you received a check, you may safely deposit it. If your letter indicated a negative incentive, that total amount is also correct, and will be withheld from claims payments as indicated in the original letter. We will be sending a revised letter with the correct breakdown by episode in the next few days. We apologize for the confusion this error caused, and assure you that the total incentive amount indicated on the letter is accurate.

Capping Hydration Codes Billed with Modifier 59

Hydration Codes impacted: 96360 – 96368 currently receiving denials “ys” and “xX” when billed with modifier 59.

Reducing denials by more than 50%, the health plan will implement a cap for billed charges at $200 for Medicaid and $150 for Medicare. 

  • This is a system edit, where if the services are billed with modifier 59, under the billed charge limit, the service will pay without requiring medical records. 
  • It is based on the code billed, not specific claim type ER, etc.
  • Timeframe for configuration: It is estimated that it will take approximately 8-weeks to be in production. 
  • While configuration is in process, we will pull a claims report for DOS January 1, 2021 to December 31, 2021 and have them reprocessed.    
  • After the system update, we will create another project to capture any claims with dates of service in 2022.