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As an overall summary of these updates, ODM announced it will begin to launch its Next Generation Medicaid program beginning July 1, All current Etactics customers will still be able to submit their Ohio Rise Claims through Etactics beginning on July 1, and will continue to do so once the new OMES system is also available. On July 1, Ohio RISE will begin to provide coordination and specialized services to help children and youth with behavioral health needs who receive care across multiple systems.
From a billing and reimbursement perspective, this does mean that most all Ohio RISE services from treatment providers will be billed through Aetna beginning on this date. We at Etactics still believe that there are some unknowns as of this date as to how some of these billing functions and processes will be carried out. This is the stage that is most related to our services here at Etactics.
During the last three months of Q4 , ODM will finish implementing the Next Generation program with all seven Next Generation managed care entities plans MCEs beginning to provide healthcare coverage under the new program. ODM will also complete the OMES implementation including the Fiscal Intermediary FI which is intended to simplify and streamline the provider process for submitting claims and prior authorizations. Etactics will continue testing with ODM as a Pilot Clearinghouse with the intention of being able to submit all claims and transactions through the Fiscal Intermediary on behalf of our clients and future clients.
Likewise, Etactics is dedicated to providing our clients with up-to-date information regarding the change and making the migration as smooth as possible. In July , Ohio Medicaid changed how it paid addiction treatment and mental healthcare by allowing private companies to manage Medicaid plans on behalf of the state. The state introduced it in phases over several months. Each phase included huge adjustments for claim submissions.
The redesign made it harder to use manual processes since there are more payers, making it unmanageable. Behavioral health organizations had to define new workflows for how they would submit claims and correct denials. There will also be a new Fiscal Intermediary as well, all beginning Q4 Etactics will have connections to all of the new additions as well as the Fiscal Intermediary and Ohio Rise. We will continue to assist our customers in this next critical transition period.
We wanted to take this opportunity to provide you with an update on the upcoming changes to the ODM "Next Generation" claims submission processes now going into effect on Q4 and the efforts of Etactics to best help our customers prepare for these critical changes.
As of this update, Ohio Rise is still scheduled on July 1, Etactics customers will still be able to submit Ohio Rise claims to Etactics. We have passed our security and connectivity protocols and are now in the middle of actual claims testing for the new OMES system. If there is anything that you currently do directly today that is independent of these functions, please let us know and we can gather additional clarification.
We plan to provide regular updates to all of our Ohio customers on this project as we continue to test and gain clarity on these new processes. From what we have understood so far, we anticipate some additional setup configurations regarding:. Member policy numbers.
Payer ID's. There will also be some new and additional "SNIP" edits and Etactics is aware of those and we are also mapping any new error or rejection messages that we see coming over in testing. Please let me know if you have any other specific questions and will attempt to get further clarification if needed and as processes are confirmed with our testing.
Unfortunately, this new process does not appear to be as simple as ODM might have thought but rest assured, we are very confident that our clients will be provided with as much advanced knowledge as soon as we have continued updates and details. As such, we would like to share some helpful information on the new Fiscal Intermediary and its connections. Current members and current customers of ours will still be able to go through Etactics to submit to the Fiscal Intermediary.
Some members might opt to go direct, but for those still wanting to use Etactics, we will also have that connection. We also have connections to all of the newly awarded MCO's Humana, Anthem, AmeriHealth Caritas just in case you need to connect electronically with them prior to the official switch.
Buckeye Health is still in a "deferred" status. We believe in our preparedness to help Ohio agencies in a number of ways, regardless of their claims mix. Yet, Commercial payers will still need to go through a clearinghouse. The new Ohio Rise program and associated Aetna claims will still need confirmation on its process and Etactics can handle it for you. Paramount issued a lawsuit to the state of Ohio, which will delay the MCO awards slated to start in and the use of the new fiscal intermediary.
Regarding the key areas of telehealth, please be assured that telehealth will still be a viable option for all behavioral health groups going through Ohio Medicaid and the MCOs, but the commercial insurance plans may have their own individual rules, waivers and transition plans. Your licensing board still dictates which rules must be followed. In their memo to licensees, the CSWMFT Board announced that licensees must immediately return to complying with telehealth rules in that require face-to-face visits, including audio-visual services for all new clients, obtain written informed consent for services for all new clients, and use HIPAA compliant technology for telehealth services for all new and existing clients.
Upon receipt of this information, the Ohio Council engaged in immediate advocacy to address the significant impact this decision has on client access to care and business operations. At Buckeye Health Plan we understand how important you and your family's healthcare needs are.
Buckeye Health is a Medicaid plan for adults and children in Ohio. Eligibility is determined by family size and income. Enrollment is done through the Department of Medicaid, located on the web at www. At Buckeye Health Plan, we believe that access to high-quality Ohio healthcare should be easy and local.
We are here to help individuals and families through the Ohio Medicaid enrollment process. You can apply for Ohio Benefits year-round if you are eligible. Learn more and enroll today! Buckeye Health Plan. Why Buckeye Health Plan? Is it Right for Me? Buckeye News.
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|Mmis number caresource||Your health insurance group number is assigned to the employer that bought your plan It helps pinpoint the exact benefits that your plan offers It is a different number than your member ID number This group number is used by your medical provider for billing purposes. Address Correction. Likewise, Mmis number caresource is dedicated to providing our clients with up-to-date information regarding the change and making the migration as smooth as possible. EDI and Clearinghouse. We have passed our security and connectivity protocols and are now in the middle of actual claims testing for the new OMES system.|
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