Updates
May 2023
As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. This is to inform you of the revision to existing Medicare and Marketplace effective 7-1-23.
Policy Number |
Policy Name |
Policy Description |
Lines of Business |
|---|---|---|---|
CP.MP.100 |
Allergy Testing and Therapy |
Change codes 86160, 86161 and 86162 from not payable to NOT payable only when billed with the following diagnosis codes:, B44.81, H10.01* through H10.45, J30.1 through J30.9, J30.0, J31.0, J45.2* through J45.998 , L20.84 , L20.89, L20.9, L23.0 through L23.9*, L25.1 through L25.9, L27.0 through L27.9 , L50.0, L50.1, L50.6, L50.8, L50.9, L56.1, L56.2, L56.3, R06.2, T36.0X5A through T50.995S , T63.001* - T63.94*, T78.00X* through T78.1XXS, T78.49XA through T78.49XS , T80.52XA through T80.52XS, T88.6XXA through T88.6XXS , Z88.0 through Z88.9, Z91.010 through Z91.018,
Add the following diagnosis codes as payable with 86003, 86005, 86008, 95004, 95017, 95018, 95024, 95027 and 95028. L20.0, L20.81-L20.83, L24.9, L30.2.
Add CPT 86001 as NOT payable. |
Medicare & Marketplace |
CP.MP.97 |
Testing for Select Genitourinary Conditions
|
Added 0330U and 0352U as not med nec for members over age 13 (new code for July '22 with no utilization/cost data).
Changed matching requirements for ICD-10 B37.3 to apply to B37.31 and B37.32 which together now replace B37.3. There will be no savings change from this edit.
Changed CPT 87481 from not medically necessary in any circumstance to not med nec when paired with the following dx codes, and only applied to members 13 years and over. Required the same dx code matching for new code 0353U (with no utilization/cost data): B37.31, B37.32, L29.2, L29.3, N39.0,N72, N76.0, N76.1, N76.2, N76.3, N76.81, N76.89, N77.1, N89.8, N89.9, N90.89, N90.9, N91.0 –N91.5, N92.0, N93.0, N93.8, N93.9, N94.3, N94.4 – N94.6, N94.89, N94.9, O09.00-O09.03, O09.10-O09.13, O09.A0-O09.A3, O09.211-O09. 219,O09. 291-O09. 299,O09.30-O09.33,O09. 40-O09.43, O09.511-O09.519, O09.521- O09. 529, O09.611-O09.619, O09.621-O09.629, O09.70-O09.73, O09.811-O09.819, O09.821-O09.829, O09.891-O09.899, O09.90-O09.93, O23.511– O23.93, Z00.00,Z00.8,Z01.419,Z11.3,Z11.51,Z22.330,Z23,Z30.011 – Z30.019,Z30.02, Z30.09,Z30.40 – Z30.9,Z32.00, Z33.1, Z34.00 – Z34.03, Z34.80 – Z34.83, Z34.90 – Z34.93, Z36.0-Z36.5, Z36.81-Z36.9, Z38.00 – Z38.01, Z38.30 – Z38.31, Z38.61 – Z38.69, Z39.0 – Z39.2, Z3A.00 – Z3A.49, Z72.51 – Z72.53, Z86.19, Z97.5 |
Medicare & Marketplace |
Effective July 1, 2023 Buckeye Health Plan will follow ODM guidance requiring use of the 33 modifier for the full reimbursement for filing the ePRAF. Buckeye will no longer reimburse providers the full payment unless the provider files the claim for the ePRAF with the 33 modifier as stipulated by ODM. Buckeye offered a grace period since ODM initially provided this guidance. Please refer to the chart below.
Payment for Completing the ePRAF
After completing the PRAF, submit a claim based on the guidelines below:
Code + modifier |
Description |
Fee Schedule Amount* |
|---|---|---|
H1000 + 33 |
Electronic PRAF Submission |
$90.00 |
H1000 |
Paper/Faxed version |
$12.10 |
* Provider’s contracted rate will be applied to the fee schedule rate to determine final amount.
For more information on the PRAF and proper billing please visit the following link, https://www.buckeyehealthplan.com/providers/resources/pregnancy---prenatal-information.html
Buckeye Health Plan's Payment Integrity department is implementing changes to the suite of unbundling edits with enhanced business rules to improve customer experience. Providers may see a reduction in unbundling edits starting in July of 2023, as Internal editing will reduce denials to only bundled modifier 59 code pair services which are clinically related.
We want to provide you with a heads up on upcoming enhancements to the Provider Portal Landing Page and a Pop-Up Survey you may encounter on the portal toward the end of June.
One of the most propelling reasons for the changes, is to make the page more accessible for our users. The portal is now 508 Compliant to come in line with the governments directive to ensure that disabled members of the public have comparable access. By doing this, we also ensure that everyone’s experience on the site is elevated. While none of the functionality will be changing, how the users interact with the information is changing. Below is an overview of the capabilities/modules you can expect:
- Notifications: Updated design to incorporate color coding, limit the characters allowed, and enabled the ability to set expiration dates.
- Personalized welcome with quick messages about the improved functionality.
- Admin Settings: Quick and easy access to core functionality of an Admin User.
- Quick Actions: Quick and easy access to Member Eligibility, New Claim, Recurring Claim, and Authorizations.
- Claims Overview: Dashboard of claims, segmented by Denied, Rejected, and Pending.
- Authorizations Overview: Quick access to inpatient and outpatient authorizations
- Useful links that are relevant to the user’s permissions and role.
In addition, you may encounter a Site Intercept Satisfaction Pop-Up Survey and/or a Feedback Tab Survey. To ensure you are experiencing the best possible use of the portal, we are placing short, automated pop-up intercepters to collect direct feedback from you about the portal experience.
More details and a Quick Start Guide will be coming soon.
Ohio Department of Medicaid will be hosting an opportunity to offer input and feedback on proposed updates to the CPC program administrative code rules (OAC 5160-19-01 and -02). ODM will be reviewing proposed changes, which will include updates to risk stratification, quality and efficiency metrics, and activities.
This meeting will take place on Thursday June 1, 2023 from 2:00 p.m. – 3:00 p.m. via GoToWebinar. If interested, please register here.
Medicare Member Plan Benefits Resume for Applicable COVID-19 Testing, Screening, and Treatment Services on May 12, 2023
Earlier this year, the Biden Administration announced that the federal Public Health Emergency (PHE) related to the COVID-19 pandemic will end on May 11, 2023.
During the PHE, we followed guidance from the Centers for Medicaid & Medicare Services (CMS) and instituted temporary waivers for select services. This action ensured that critical care could be quickly delivered to our members during a time of heightened need. Beginning May 12, 2023, these temporary waivers will expire, and our members’ Medicare plan benefits will be reinstated for the following services:
Service |
Member Liability |
Prior Auth Needed? |
|---|---|---|
COVID-19 Testing and Screening (Administered by Provider) |
Per member plan benefits |
No |
COVID-19 Vaccinations |
$0 member cost-share for vaccine administration* |
No |
COVID-19 Monoclonal Antibody Treatments |
$0 member cost-share for treatment administration* |
Prior authorization only required for CPT code Q0221 |
*Vaccine ingredient cost is still covered directly by Medicare FFS.
Alongside these waivers, the Coronavirus Aid, Relief, and Economic Security (CARES) Act provided for a 20% increase to the inpatient prospective payment system (IPPS) Diagnosis Related Group (DRG) rate for COVID-19 patients for the duration of the public health emergency. This increase applied to claims that included the applicable COVID-19 ICD-10-CM diagnosis code and met the date of service requirement. When the PHE ends on May 11, 2023, these add-on payments will no longer be included for discharge dates of service as of May 12, 2023 and thereafter.
Wellcare by Allwell is committed to providing a smooth transition for both our members and providers as we resume business as usual. While we will continue to communicate any updates to our business practices directly to our provider partners, we always highly recommend that providers verify member eligibility, benefits, and prior authorization requirements before rendering services.
April 2023
End Date of Public Health Emergency (PHE) and PASRR Impact
In March 2020, the Ohio Department of Medicaid (ODM) made a number of operational changes to its Medicaid program in response to the COVID-19 public health emergency (PHE). These changes included taking advantage of the flexibilities offered to states including but not limited to allowing nursing facilities to delay the completion of the Preadmission Screening and Resident Review (PASRR) for 30-days.
On February 9, 2023, the Department of Health & Human Services announced that the PHE will end on May 11, 2023. While there were various flexibilities granted, the 30-day delay of PASRR Level I screenings and Level II evaluations will terminate on May 11, 2023.
As such, the Center for Medicare and Medicaid Services expect states to resume full PASRR activities in accordance with state PASRR rules (OAC 5160-3-15, OAC 5160-3-15.1 and OAC 5160-3-15.2) as of May 12, 2023. Therefore, providers must also return to the pre-PHE timeframes for completing PASRR requirements and related level of care requests. As a reminder, level of care determinations must not precede the date the PASRR requirements were met.
For additional questions, please submit them to PASRR@medicaid.ohio.gov
April 14, 2023: Who to bill for physical health services provided to OhioRISE enrollees
April 12, 2023: Register Now for Provider Network Management Refresher Training
April 12, 2023: April Electronic Visit Verification webinar on August 18
Medicaid Providers Note:
We identified an issue where 835 files from Buckeye were not being received by OMES; therefore 835 files sent between February 1 to March 20, 2023, may be reprocessed which could cause duplication. Please make staff aware of this possibility to ensure the file is not posted a second time. If you have any questions, please reach out to Provider Services at 866-296-8731.
We apologize for any inconvenience this may cause and thank you in advance for your understanding.
March 2023
Service Code |
Service/Procedure Description |
Comments |
|---|---|---|
A4239 (Formerly Code K0553, now retired) |
Supplies, Continuous Glucose Monitoring |
Allow 1 unit per month billed- PA required for over benefit limit only |
E2103 (Formerly Code K0554, now retired) |
Receiver/Monitor, Continuous Glucose Monitor |
Allow 1 monitor every 3 years- PA required for over benefit limit only |
A9277 |
External Transmitter |
Allow up to 2 per benefit year- PA required for over benefit limit only |
|
|
|
A9278 |
External Receiver/Monitor |
Allow 1 per benefit year- PA required for over benefit limit only |
March 6, 2023: Temporary Redirection of Claims from ODM to MCEs
February 2023
Policy Number |
Policy Name |
Policy Description |
|---|---|---|
CP.MP.96 |
Ambulatory EEG |
Policy is being retired across all lines of business |
CP.MP.149 |
Testing for Rupture of Fetal Membranes |
Policy is being retired across all lines of business due to changes in standards of care. |
CP.MP.113 |
Holter Monitors |
Retiring for Medicare only as the LCDs are more lenient |
CP.MP.139 |
Low-frequency ultrasound wound therapy |
Retiring for Medicare only as the LCDs are more lenient |
CP.MP.152 |
Measurement of Serum 1,25-dihydroxyvitamin D |
Retiring for Medicare only as the LCDs are more lenient |
CP.MP.38 |
Ultrasound in Pregnancy |
Added new-for-2022 diagnosis codes as medical necessity/payable with 76811 |
CP.MP.134 |
Evoked Potential Testing |
Changed configuration so the edits don't apply to outpatient surgeries by matching revenue codes Retire for Medicare |
OC.UM.CP.0026 |
Extended Ophthalmoscopy |
Add the following ICD-10 codes to the list of diagnoses that are payable when billed with 92201/92202: , E09.37X1, E09.37X2, E09.37X3, E10.37X1, E10.37X2, E10.37X3, E11.37X1, E11.37X2, E11.37X3, H20.011, H20.012, H20.013, H20.021, H20.022, H20.023, H20.031, H20.032, H20.033, H20.041, H20.042, H20.043, H20.11, H20.12, H20.13, H20.21, H20.22, H20.23, H20.811, H20.812, H20.813, H20.01, H20.02, H20.03, H21.301, H21.302, H21.303, H21.311, H21.312, H21.313, H21.321, H21.322, H21.323, H21.341, H21.342, H21.343, H21.351, H21.352, H21.353, H21.531, H21.532, H21.533, H21.541, H21.542, H21.543, H21.551, H21.552, H21.553, H35.051, H35.052, H35.053, H35.21, H35.22, H35.23, H47.231, H47.232, H47.233, P07.01, P07.02, P07.03, P07.14, P07.15, P07.16, P07.17, P07.18, P07.21, P07.22, P07.23, P07.24, P07.25, P07.26, P07.31, P07.32, P07.33, P07.34, P07.35, P07.36, P07.37, P07.38, P07.39, Q85.01, Q85.02, Q85.03, S05.41XA, S05.41XD, S05.41XS, S05.42XA, S05.42XD, S05.42XS, T74.4XXA, T74.4XXD, T74.4XXS. Remove the following ICD-10 codes to the list of diagnoses that are payable when billed with 92201/92202:, H31.101, H31.102, H31.103, S05.71XA, S05.71XD, S05.71XS, S05.72XA, S05.72XD, S05.72XS Retire all edits for Medicare LOB as the LCDs are more lenient
|
OC.UM.CP.0028 |
Fluorescein Angiography |
Add the following ICD-10 codes to the list of diagnoses that are payable when billed with 92235: B20, B39.5, H33.111, H33.112, H33.113, H35.21, H35.22, H35.23, H35.361, H35.362, H35.363, H43.11, H43.12, H43.13, H43.821, H43.822, H43.823, Q14.8 Retire all edits for Medicare LOB as the LCDs are more lenient. |
OC.UM.CP.0029 |
Fundus Photography |
Add the following ICD-10 codes to the list of diagnoses that are payable when billed with 92250: Add the following ICD-10 codes to the list of diagnoses that are payable when billed with 92250: A51.43, A52.15, B25.8, G93.2, H33.121, H33.122, H33.123, Q14.8, S05.41XA, S05.41XD, S05.41XS, S05.42XA, S05.42XD, S05.42XS, S05.61XA, S05.61XD, S05.61XS, S05.62XA, S05.62XD, S05.62XS, Z85.840. Remove the following ICD-10 codes from the list of diagnoses that are payable when billed with 92250:, C69.01, C69.02, C69.11, C69.12, C69.51, C69.52, D49.89, Q87.1 Retire all edits for Medicare LOB as the LCDs are more lenient. |
OC.UM.CP.0043 |
External Ocular Photography |
Add the following ICD-10 codes to the list of diagnoses that are payable when billed with 92285: , A18.51, A18.54, A50.31, B00.53, B30.0, B30.1, B30.2, B30.3, C44.1922, C44.1991, C44.1992, C69.51, C69.52, C69.61, C69.62, C69.81, C69.82, D09.21, D09.22, D31.51, D31.52, H00.011, H00.012, H00.014, H00.015, H00.021, H00.022, H00.024, H00.025, H00.031, H00.032, H00.034, H00.035, H00.11, H00.12, H00.14, H00.15, H02.881, H02.882, H02.884, H02.885, H02.88A, H02.88B, H04.011, H04.012, H04.013, H04.021, H04.022, H04.023, H04.031, H04.032, H04.033, H04.111, H04.112, H04.113, H04.131, H04.132, H04.133, H04.161, H04.162, H04.163, H04.311, H04.312, H04.313, H04.321, H04.322, H04.323, H04.331, H04.332, H04.333, H04.411, H04.412, H04.413, H04.421, H04.422, H04.423, H04.431, H04.432, H04.433, H04.511, H04.512, H04.513, H04.521, H04.522, H04.523, H04.531, H04.532, H04.533, H05.011, H05.012, H05.013, H05.021, H05.022, H05.023, H05.031, H05.032, H05.033, H05.041, H05.042, H05.043, H05.111, H05.112, H05.113, H05.121, H05.122, H05.123, H05.211, H05.212, H05.213, H05.221, H05.222, H05.223, H05.231, H05.232, H05.233, H05.241, H05.242, H05.243, H05.251, H05.252, H05.253, H05.261, H05.262, H05.263, H05.311, H05.312, H05.313, H05.321, H05.322, H05.323, H05.331, H05.332, H05.333, H05.341, H05.342, H05.343, H05.351, H05.352, H05.353, H05.411, H05.412, H05.413, H05.421, H05.422, H05.423, H05.51, H05.52, H05.53, H05.811, H05.812, H05.813, H05.821, H05.822, H05.823, H16.241, H16.242, H16.243, H20.11, H20.12, H20.13, H20.21, H20.22, H20.23, H20.811, H20.812, H20.813, H20.821, H20.822, H20.823, H21.331, H21.332, H21.333, H21.561, H21.562, H21.563, H21.81, H27.111, H27.112, H27.113, H27.121, H27.122, H27.123, H27.131, H27.132, H27.133, H44.011, H44.012, H44.013, H44.111, H44.112, H44.113, H44.121, H44.122, H44.123, H44.131, H44.132, H44.133, S00.211A, S00.212A, S00.221A, S00.222A, S00.241A, S00.242A, S00.251A, S00.252A, S00.261A, S00.262A, S05.01XA, S05.01XD, S05.01XS, S05.02XA, S05.02XD, S05.02XS. Remove the following ICD-10 codes from the list of diagnoses that are payable when billed with 92285:, C44.131, H18.501, H18.502, H18.503 Retire all edits for Medicare LOB as the LCDs are more lenient. |
OC.UM.CP.0063 |
Visual Field Testing |
Add the following ICD-10 codes to the list of diagnoses that are payable when billed with 92081-3: , B58.01, C75.3, C79.31, D35.4, D43.3, E05.20, E05.21, E05.30, E05.31, E05.40, E05.41, G45.1, G45.2, G46.0, G46.1, G46.2, H02.211, H02.212, H02.214, H02.215, H02.21A, H02.21B, H02.21C, H02.221, H02.222, H02.224, H02.225, H02.22A, H02.22B, H02.22C, H02.231, H02.232, H02.234, H02.235, H02.23A, H02.23B, H02.23C, H02.841, H02.842, H02.844, H02.845, H02.851, H02.852, H02.854, H02.855, H05.121, H05.122, H05.123, H17.01, H17.02, H17.03, H17.11, H17.12, H17.13, H17.811, H17.812, H17.813, H17.821, H17.822, H17.823, H21.331, H21.332, H21.333, H31.011, H31.012, H31.013, H31.021, H31.022, H31.023, H33.121, H33.122, H33.123, H43.01, H43.02, H43.03, H43.11, H43.12, H43.13, H43.21, H43.22, H43.23, H43.311, H43.312, H43.313, H43.821, H43.822, H43.823, H44.21, H44.22, H44.23, H44.311, H44.312, H44.313, H44.411, H44.412, H44.413, H44.421, H44.422, H44.423, H44.431, H44.432, H44.433, H44.441, H44.442, H44.443, H44.511, H44.512, H44.513, H44.521, H44.522, H44.523, H44.531, H44.532, H44.533, H44.611, H44.612, H44.613, H44.621, H44.622, H44.623, H44.631, H44.632, H44.633, H44.641, H44.642, H44.643, H44.651, H44.652, H44.653, H44.691, H44.692, H44.693, H44.711, H44.712, H44.713, H44.721, H44.722, H44.723, H44.731, H44.732, H44.733, H44.741, H44.742, H44.743, H44.751, H44.752, H44.753, H44.791, H44.792, H44.793, H44.811, H44.812, H44.813, H44.821, H44.822, H44.823, H53.451, H53.452, H53.453, H57.02, H57.03, H57.04, H57.051, H57.052, H57.053, I60.2, I63.013, I63.033, I63.113, I63.133, I63.313, I63.323, I63.333, I63.343, I63.413, I63.423, I63.433, I63.443, I67.850, M31.6, S05.11XA, S05.11XD, S05.11XS, S05.12XA, S05.12XD, S05.12XS, S06.0X0A, S06.0X0D, S06.0X0S, S06.0X1A, S06.0X1D, S06.0X1S, S06.0X9A, S06.0X9D, S06.0X9S, S06.1X0A, S06.1X1A, S06.1X2A, S06.1X3A, S06.1X4A, S06.1X5A, S06.1X6A, S06.1X9A, S06.2X0A, S06.2X1A, S06.2X2A, S06.2X3A, S06.2X4A, S06.2X5A, S06.2X6A, S06.2X9A, S06.300A, S06.301A, S06.302A, S06.303A, S06.304A, S06.305A, S06.306A, S06.309A, S06.310A, S06.311A, S06.312A, S06.313A, S06.314A, S06.315A, S06.316A, S06.319A, S06.320A, S06.321A, S06.322A, S06.323A, S06.324A, S06.325A, S06.326A, S06.329A, S06.340A, S06.341A, S06.342A, S06.343A, S06.344A, S06.345A, S06.346A, S06.349A, S06.350A, S06.351A, S06.352A, S06.353A, S06.354A, S06.355A, S06.356A, S06.359A, S06.370A, S06.371A, S06.372A, S06.373A, S06.374A, S06.375A, S06.376A, S06.379A, S06.380A, S06.381A, S06.382A, S06.383A, S06.384A, S06.385A, S06.386A, S06.389A, S06.4X0A, S06.4X1A, S06.4X2A, S06.4X3A, S06.4X4A, S06.4X5A, S06.4X6A, S06.4X9A, S06.5X0A, S06.5X1A, S06.5X2A, S06.5X3A, S06.5X4A, S06.5X5A, S06.5X6A, S06.5X9A, S06.6X0A, S06.6X1A, S06.6X2A, S06.6X3A, S06.6X4A, S06.6X5A, S06.6X6A, S06.6X9A, S06.810A, S06.811A, S06.812A, S06.813A, S06.814A, S06.815A, S06.816A, S06.819A, S06.820A, S06.821A, S06.822A, S06.823A, S06.824A, S06.825A, S06.826A, S06.829A Retire all edits for Medicare LOB as the LCDs are more lenient. |
In response to your feedback, we have removed 16 services from our prior authorization list effective April 1, 2023:
Service Code |
Service/Procedure Description |
Comments |
|---|---|---|
81220 |
Cystic Fibrosis Carrier Screen |
|
97110 |
PT Services |
|
81420 |
Fetal Chromosomal Screen |
|
81206 |
Familial dysautonomia |
|
20550 |
Injections ganglion cysts/plantar fascia |
|
20605 |
Arthrocentesis, aspiration and/or injection, intermediate joint or bursa |
|
86832 |
Antibody testing human leukocyte antigens (HLA) |
|
64885 |
Nerve Graft Required PA for Non Par only. This will now be NO AUTH REQUIRED FOR ALL PROVIDERS |
|
97530 |
Therapeutic Activities |
|
77002 |
Fluoroscopic guidance for needle placement |
No PA for All Providers |
81546 |
Testing (genetic) with Thyroid Biopsies |
|
92507 |
Speech Treatments |
|
41899 |
Facility charges around dental procedures done in hospital OR or Outpatient Surgery locations |
No PA for All Providers |
00170 |
Anesthesia charges for dental procedures done in hospital surgery, Outpatient Surgery locations |
|
Buckeye Health Plan is aligning with Ohio Department of Medicaid PA requirements for Continuous Glucose Monitoring supplies. PA requirements for network providers will be required if monthly/yearly amounts are more than the ODM recommended amounts below:
Service Code |
Service/Procedure Description |
Comments |
|---|---|---|
K0553 |
Supplies, Continuous Glucose Monitoring |
Allow 1 unit per month billed- PA required for over benefit limit only |
A9277 |
External Transmitter |
Allow up to 2 per benefit year- PA required for over benefit limit only |
Buckeye Health Plan is adding Prior Authorization Requirements for the following code effective April 1, 2023:
Service Code |
Service/Procedure Description |
Comments |
|---|---|---|
A6549 |
Gradient Compression Stocking |
|
As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. This is to inform you of coding changes Buckeye will be implementing effective on or after 4/1/2023.
Coding |
Description |
LOBs Impacted |
|---|---|---|
Inappropriate Primary Diagnosis |
This edit is created based on ICD-10 coding guidelines to deny claims when billed with unacceptable primary/ principal diagnosis, manifestation diagnosis, and sequela diagnosis in an outpatient or inpatient facility. ICD-10-CM Official Guidelines for Coding and Reporting identifies diagnosis codes that should never be billed as primary on an outpatient hospital (UB-04) claim form or its electronic equivalent.
|
Medicaid/ Marketplace/ Medicare |
Interim Claims |
Based on CMS guidelines, bill type ending in XX2 or XX3 will be denied when discharge status 30 is not present on the claim.
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Medicare |
January 2023
December 2022
December 19, 2022: New version of the BH Provider Manual 1-1-2023
December 15, 2022: OhioRISE Mixed Services Protocol Updated December 8, 2022
December 15, 2022: Ambetter Providers - NCQA Letter
December 13, 2022: ODM Message - What to Expect on February 1, 2023
December 9, 2022: MITS Medicaid Payment Rates for CANS Assessments Will Increase January 1, 2023
December 9, 2022: December 9, 2022: “MITS BITS” is being replaced with “BH Bulletin”
December 9, 2022: MITS Claims Payment Error Resolved
December 7, 2022: ODM Message - Latest on Phase 3 move to February 1, 2023
- Anyone accessing the PNM or the SPBM secure web portal will need an OH|ID to log in and complete key administrative tasks and processes. The following resources are available to providers assist in setting up an account.
- Providers needing technical assistance should contact the Ohio Department of Medicaid Integrated Help Desk (IHD) at 1-800-686-1516. Hours of operation are Monday-Friday, 8 a.m. - 4:30 p.m. ET.
August 2022
(ODM apologizes for the error found in a communication sent out earlier this month. They stated that all demographic updates, including the CPC contact information, needed to be done in the MITS system by Aug 20 or the change will have to be held until Oct 1. The correct date is Aug 31st. Please see the corrected communication below.)
CPC Enrollment for the 2023 Program Year
The enrollment period for the CPC program is again slated for October. ODM anticipates sending out invitations to those who are eligible in early September 2022. Invitations will be sent via email to the CPC contact found in the MITS Secure Provider Portal.
Beginning Aug. 31, all provider demographic and agent maintenance update functionality will be closed for conversion of data in MITS. ENROLLED PROVIDERS SHOULD UPDATE THEIR DEMOGRAPHIC INFORMATION IN MITS BY AUGUST 31 or plan to hold updates until Oct. 1. It is therefore vital to make sure updates are completed by Aug. 31 to ensure all CPC invitations are received.
For assistance with how to update your demographic information, refer to the training video found on the ODM website. If additional assistance is needed, contact the Provider Hotline 800-686-1516.
July 2022
June 2022
- June 28, 2022: Coverage of psychiatric or substance use disorder inpatient admissions for youth
- June 21, 2022: Update to June 16, 2022 Practitioner Modifiers on Aetna OhioRISE Claims
- June 15, 21022 Informational Update - Extension of Reimbursement to non-VFC providers
- ODM has announced the availability of the recorded OhioRISE 1915(c) Home and Community Based Waiver training held on May 18. Click here for details and access.
May 2022
April 2022
- OhioRISE Home and Community Based Waiver training-Wednesday, May 18
- June 9 Comprehensive Primary Care (CPC) Webinar is on Big 5 initiatives
- Ohio Medicaid’s Next Generation program to launch July 1 with OhioRISE | Medicaid
- Effective April 13, 2022, Buckeye is following ODM guidance to rescind the lift of all prior authorizations and/or pre-certifications for all long-term acute care facility (hospital), skilled nursing facility (SNF), and Inpatient Rehabilitation facility (IRF-hospital) admissions
- New Short Stay Policy effective May 1
- ODM Freeze on MITS system process and update information