COLUMBUS — The Ohio Department of Medicaid issued a statement Thursday regarding payment delays to independent caregivers and other health providers.
“As Ohio Department of Medicaid introduced foundational changes to its next generation of managed care, beginning with the July 1, 2022, launch of OhioRISE, the department offered providers interim options for submitting claims until we complete the full implementation of the Next Generation program,” the agency said in an emailed statement to The Lima News Thursday.
“On Feb. 1, Ohio Medicaid introduced new, ‘next generation’ electronic data interchange (EDI) processes and requirements that support 90% of total provider claims that come to Medicaid. A majority of these are submitted by trading partners – outsourced IT vendors hired by providers to manage electronic billing, coding, transmissions, etc. – and most claims are being submitted as expected. However, the overall volume is lower than anticipated, indicating a percentage of trading partners have not yet tested nor become familiar with the new requirements.
As with any new system or process change, getting familiar with new steps and requirements takes time and practice. The department introduced a variety of provider and trading partner supports in preparation for the Feb. 1 transition including establishing technical teams that reached out directly to trading partners, training teams, and multiple provider help desks to resolve issues. We are working alongside providers, provider partners, and managed care plans to educate and train them on systems upgrades and to resolve technical barriers they may be experiencing. We are making constant improvements to adjust as problems are identified.”
