The Academy of Senior Health Sciences, Inc. (formerly The Ohio Academy of Nursing Homes, Inc.) seeks to provide public education and awareness initiatives to the long-term care community in Ohio. Our membership represents a true cross-section of the skilled nursing facility profession, from small sole proprietorships to larger Ohio-based multi-facility companies, as well as those businesses that service our industry. Through our public education and awareness efforts, the Academy brings the collective influences of the members together into a single voice on vital issues affecting our profession.
Founded in 1966, the Academy then identified one of its core purposes as "To foster a spirit of goodwill among those persons engaged in the nursing home industry, to promote ethical practices in their relationships with each other, their employees, and the general public to the end that all interests may be served fairly..." Though the organization has undergone several transformations over the years, most notably in 2011, its dedication and commitment to Ohio's most frail and elderly remains the same.
| The Academy Weekly Headlines from 2 Weeks Ago|
ODM delays SNF FPF payment due date
The Ohio Department of Medicaid has delayed the latest installment of the SNF Franchise Permit Fee payment to ten days after the funds from H.B. 45 are disbursed. From ODM: "With regard to the February franchise fee payment, ODM will not be taking enforcement actions for late payment. Understanding the current challenges faced by nursing facilities, ODM is willing to use its discretion and refrain from taking enforcement action pursuant to ORC 5168.51 and 5168.52 until ten (10) calendar days have elapsed following the disbursement of the NF HB 45 funds. For any franchise permit fees not received by the end of this 10-day period, ODM may pursue enforcement action. This discretion is only applicable to the February 2023 payment. The HB 45 fund distribution are not Medicaid payments; however, ODM will be working with OBM to ensure an expedited distribution of funds. Thank you for your continued work during this challenging time."
January 1 SNF rates released
ODM released the January 1 SNF rates, which update facilities' case-mix scores used in the direct care rate. Please click here to view rates in an excel file.
ODM EDI: Eight things to know
The Ohio Department of Medicaid continues to provide information to providers as they prepare to move into Phase III of the Next Gen Medicaid Managed Care. From ODM regarding the February 1, 2023, launch of the Electronic Data Interchange (EDI):
- The new EDI, supported by the vendor Deloitte, is replacing the current EDI.
On February 1, the new EDI will be the exchange point for trading partners on all claims-related activities including claim status and eligibility. All trading partner claims must be submitted directly to the EDI, regardless of whether the member is receiving benefits through Medicaid fee-for-service (FFS) or one of the Next Generation managed care plans. Please note that MyCare is not included in the Next Generation program and will continue to use current processes.
Providers who submit managed care claims through direct data entry (DDE) will do so via the appropriate managed care portal. All managed care prior authorizations will continue to be submitted to the respective managed care portals or through their respective processes. Additionally, FFS direct data entered claims and prior authorizations will continue to be submitted through the Provider Network Management (PNM) module via a link to Medicaid Information Technology System (MITS).
- There is a change in policy about rendering providers on claims.
For EDI‐related claims submissions, ODM now requires one rendering provider per claim at the header level, rather than the detail level, for professional claims for both FFS and managed care recipients. Different rendering providers at the detail level are no longer acceptable. Exceptions for FFS Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) providers are detailed in the Medicaid Advisory Letter 622.
- Provider claims submitted to trading partners must use the ODM-assigned Medicaid member ID (MMIS).
The Medicaid ID should be obtained with each visit. The Medicaid ID must be used on all EDI claim submissions. Member eligibility can be verified using the PNM portal, which redirects to MITS, or using the 270 /271 eligibility transaction in EDI.
- There will be system downtime leading up to February 1.
As we transition to the new EDI, there will be system downtime for processing of trading partner claims. They are as follows:
During this time ODM will not accept claims submitted via trading partners. Please work with your trading partner to discuss any changes or impacts to your submissions.
- January 25-31: There will be an FFS (837 P/I/D) claims transition period.
- January 30-31: There will be a member and claim inquiry blackout.
- Pay attention to claims date of service when submitting for adjudication.
Beginning February 1, all claims with a date of service on or after the February 1 launch must be submitted through the new EDI vendor, Deloitte. Please work with your trading partner to ensure claims with the appropriate dates of service are handled correctly beginning February 1.
- Check that your trading partner is authorized to work with ODM.
All clearinghouses or trading partners who are already authorized to submit claims to ODM will continue to have access to submit claims on behalf of providers. Please contact your trading partner to ensure they are ready to .
- Each managed care claim must include the internal managed care payer ID and a receiver ID.
All managed care claims submitted through the new EDI must include the internal managed care payer ID and a receiver ID. Please see the ODM Companion Guides for a full list of the updated receiver and payer IDs. Please note the payer and receiver IDs for FFS claims have not changed.
- Providers must submit attachments in the original method of claim submission.
Claim attachments must be submitted via the same method as the claim submission. For example, for a claim submitted via DDE, an attachment must also be done using DDE. For EDI transactions, please work with your trading partner on how to upload attachments. This is similar to the adjustment policy we detailed in the December 12 edition of the ODM Press."
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