IMPORTANT: Medicaid Agreement Revalidations in the Provider Network Management Module
Ohio Department of Medicaid (ODM) resumed provider revalidation notices in June 2023 as part of the federally required unwinding process from the COVID public health emergency. ODM issues a series of notices with the first one delivered 120 days prior to your Medicaid agreement end date. Subsequent reminders are issued at 90 days, 60 days, and a final notice at 30 days. If you receive a revalidation notice, it is imperative that you take action to complete your revalidation on time. All providers are subject to either 5-year or 3-year time-limited provider agreements.
How do you know if you are due for revalidation?
- Check your mail and email.
Revalidation reminder notices are mailed and emailed to providers who are due for revalidation prior to the end of their Medicaid agreement. The email will be sent from OHPNM@maximus.com and will advise that there is a revalidation correspondence in the Correspondence folder in Provider Network Management (PNM) module. Please check your spam folder for this email.
- View the Correspondence folder in the PNM module.
Revalidation notices are posted in the PNM module and can be accessed in the Correspondence folder. Please be sure to select the type of correspondence from the drop down (in this case <Enrollment Notices>), and search for the “Revalidation Notices.” Review the Accessing Communications within PNM Quick Reference Guide for step-by-step instructions.
NOTE: If you think you are due for revalidation but have not received notices, please login to the PNM module and verify that the primary contact information is accurate in accordance with your Ohio Medicaid Provider Agreement. All mailers and email notices are directed to the primary contact individual or address identified in the system.
If I am due for revalidation, what action do I need to take?
A “Begin Revalidation” option appears in the PNM Enrollment Action Selections 120 days prior to the Medicaid Agreement end date. This can be found under the “Manage Application”, “Enrollment Actions” option within the provider file. Review the Revalidation/Reenrollment Quick Reference Guide for step-by-step instructions.
Credentialed providers whose revalidation date has passed will not see the “Begin Revalidation” option. ODM expects to provide the “Begin Revalidation” option for these credentialed providers through a PNM module starting October 26.
IMPORTANT UPDATE:
If you are currently in a PNM revalidation cycle, it is imperative that you take immediate action to complete and submit your revalidation to renew your Ohio Medicaid Provider Agreement. However, ODM is NOT currently terminating providers that fail to revalidate. As a reminder, revalidations resumed for providers due October 1 and after, following the end of the public health emergency.
UPDATE State Fiscal Year-End Claims Submission and Provider Payments
Claims submitted after 12:00pm on Friday, June 23, will be held for processing until the Ohio Administrative Knowledge System (OAKS), the state's accounting system, is up and running for state fiscal year (SFY) 2024 (beginning July 1). Ohio Department of Medicaid anticipates issuing final provider payments for SFY 2023 on Wednesday, June 28, however, fiscal year-end processing may cause a delay in payment until OAKS is up and running for SFY 2024. Ohio Department of Medicaid anticipates issuing the first payment of SFY 2024 to providers on July 7. Please note, as a result of fiscal year-end processing and the July 4th holiday, OAKS processing may experience a brief delay and payment may not be made until the week of July 10.
Important reminder: Update addresses and affiliations in the Provider Network Management (PNM) module.
It is imperative that providers update all address and affiliation information in the PNM so that claims payments, provider directories, and network adequacy measurements are not negatively impacted.
Click on the following links for step-by-step instructions on how to complete these actions.
- Updating or Adding Owner Information
- Updating or Adding Practice Locations
- Updating or Adding a Specialty in PNM
Important: Provider Network Management affiliation steps are not complete and may impact provider billing
Through a series of Provider Network Management (PNM) queries, Ohio Department of Medicaid (ODM) has identified several affiliation issues that impact billing organizations claims.It is imperative that providers fully execute all steps when affiliating a rendering provider to their group/organization/hospital to avoid claims payment issues.ODM has identified that providers tend to leave affiliations in one of two incomplete statuses:
- Pending Approval.
- Confirmed.
A provider affiliation can be initiated and completed by the group/organization/hospital, or it can be initiated through the rendering practitioner.If the affiliation is initiated through the rendering individual, it is not complete and remains in a “Pending Approval” status until the group/organization/hospital accepts and saves the affiliation. At that point it will appear“Confirmed.”For the provider affiliation to be sent downstream and receive an “Active” status, there are two remaining critical steps:
- Click “Save” at the top of the page to save all the updates. Once saved, the user will have a new “Submit for Review” button appear.
- Click “Submit for Review.”Users must click on this button to complete the process and submit the affiliations downstream.Affiliations are fully executed only once this final step has been taken.
If these steps are not completed, the provider affiliation is not sent downstream, and providers will experience claims payment issues.
For more information
The PNMLearningtab includes step-by-step instructions in three quick reference guides (QRG) under “Existing Users” for affiliation assistance. These are titled “Adding a Group Affiliation,” “Adding a Hospital Affiliation,” and “Affiliations.”
Providers wanting to view or edit a claim must use the same system that was used for the original submission
These systems include managed care entity (MCE) portals, the MITS page accessed via the PNM module, or through an authorized trading partner utilizing the new EDI portal. For example, if a provider submits a claim via an MCE portal, the provider must then use the same MCE portal to view or edit their claim. Claims submitted via trading partners are not viewable within the PNM module; however, providers can work with their trading partner to view a claim status.
Getting help with Provider Network Management module issues and questions
ResourcesonthePNMandCentralizedCredentialingpage are available to assist you in resolving the most common issues providers are experiencing.
Prescribers, pharmacists, and support staff: Single Pharmacy Benefit Manager web portal training now available
The recorded Single Pharmacy Benefit Manager (SPBM) web portal training is now available.Viewing this is important for prescribers, pharmacists, and support staff to learn about the many tools available on both the public-facing and secure portal.The public-facing portal includes access to reference material such as the Unified Preferred Drug List (UPDL) and criteria. The secure portal, which requires login credentials, provides access to specific patient information and the ability to reach the SPBM clinical helpdesk via web chat. SPBM clinical staff can also be reached via phone and email.
Accessthetrainingforprescribers,pharmacists,andsupportstaff.
If you have accessed Gainwell’s Ohio learning management system (LMS) previously, please use the same credentials set up during your initial registration to log in. If you have not, you will need to complete registration for the system to access the recording.
If you have questions, please contact Gainwell Technologies at 1-833-491-0364 or OH_MCD_PBM_network@gainwelltechnologies.com.
