Source: Ohio Department of Medicaid
On December 8, the Ohio Department of Medicaid (ODM) announced that it has awarded its Fiscal Intermediary (FI) service contract to Gainwell Technologies, taking another important step forward in delivering a person-centric next generation managed care program to Ohio. The FI service contract is a part of a larger effort to modernize ODM’s management information systems, developed in accordance with the Centers for Medicare and Medicaid Services (CMS) guidance.
- Lighten the administrative load: Providers will submit and monitor all claims and prior authorization requests through a single system vs. having to manage these transactions with each individual MCO.
- Streamline and standardize the prior authorization process: Ohio Medicaid will require MCOs to develop necessary electronic exchanges to assist with coordinating service authorization requests through ODM’s FI.
- Provide timely updates on claims and prior authorization status: Providers will have an opportunity to correct claims errors that lead to denials and expedite the review and reimbursement cycle.
The module will serve as a single clearinghouse for all provider claims and prior authorization requests, validating transactions and routing requests to the appropriate MCO for resolution and reimbursement. In addition to streamlining the claims process, the FI will strengthen ODM’s ability to assess compliance with Medicaid managed care regulations, review encounter data, and track performance measures.
“Today claims data handled exclusively by managed care organizations takes between three and six months to reach ODM health data analysts,” said Maureen Corcoran, director of ODM. “The fiscal intermediary will provide access to these critical health care transactions in real time, enabling us to adjust programs, policies, or services more efficiently.”
As the selected FI vendor, Gainwell brings more than 50 years of experience supporting state Medicaid agencies across the country. The company will implement the FI component of ODM’s technology modernization strategy, including the configuration, implementation, operation, and maintenance of the solution.