10/04/2023

Medicaid Claim Submission Reminders

The Ohio Department of Medicaid (ODM) recently provided the following update on claims submissions for all Ohio physician practices.

As part of Ohio Department of Medicaid's (ODM) comprehensive effort to modernize management information systems, providers have experienced changes in how they submit and access claims. We know this is a big change and we appreciate your partnership. ODM would like to give providers some important reminders and clarification on common questions.

Where do I submit a crossover claim? 

If Medicare has paid their portion of a claim but you do not receive ODM payment in the following ninety days, you must directly submit a corresponding crossover claim to ODM. You have the option to submit the crossover claim through the Provider Network Management (PNM) module via a link to Medicaid Information Technology System (MITS) or through a trading partner to the Electronic Data Interchange (EDI).

This direction is aligned with the Ohio Administrative Code 5610-1-05, “Medicaid coordination of benefits with the Medicare program (Title XVIII).” 

Where do I edit fee-for-service, managed care, or crossover claims?

Submit claim edits, including adjustments and voids, using the same method as the original claim submission. For example, if you submit claims through a trading partner via the EDI you should only edit claims via the EDI. If you submit claims through the PNM module via a link to MITS, you should only edit the claim in the PNM. 

Have more questions?

Additional information on the adjudication process can be found on our updated Claims and Prior Authorization Submission Frequently Asked Questions. If you have any questions or concerns, please contact ODM’s Integrated Helpdesk (IHD) at 800‐686‐1516 or email IHD@medicaid.ohio.gov. Representatives are available 8 a.m.‐4:30 p.m. EST Monday‐Friday.