The Ohio Department of Medicaid’s (ODM) next generation Fiscal Intermediary (FI) is helping ODM achieve its goal of focusing on the individual rather than the business of managed care. The FI will act as a clearinghouse for Medicaid providers, accepting and paying all Medicaid Fee-For-Service (FFS) claims and processing prior authorizations (PA) as well as accepting and forwarding all claims and PAs from providers to their designated managed care entities (MCEs). MyCare claims are an exception to this rule due to the current agreement that ODM has with the Centers for Medicare and Medicaid Services (CMS) and the MyCare Medicaid plans which will still be valid agreements at FI go-live.
- Physicians and other health care professionals will submit and monitor all claims and PA requests through the Provider Network Management Module portal which is a single system vs. having to manage these transitions with each individual MCE.
- New streamlined and standardized PA process as ODM will require MCEs to develop necessary electronic exchanges to assist with coordinating service authorization requests through ODM’s FI.
- Provide timely updates on claims and PA status so providers will have an opportunity to correct claim errors that lead to denials.
With the new FI, capitation payments will be made monthly based on the eligibility of the recipients. FFS payments will adjudicate daily, and payments will be made weekly in accordance with established policies. Each MCE has their own payment calendar, but they are mandated to pay based on the prompt pay requirements outlined in their agreement with ODM.
If you have questions about the FI, please send them to ODMFiscalIntermediary@medicaid.ohio.gov or visit the FI webpage of the next generation website