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 HOW TO: Three ways to verify member eligibility
- Log in to NaviNet®, our secure provider portal”
- Use Contact AmeriHealth Caritas Ohio’s Provider Services 1-833-644-6001, follow prompts for “member eligibility”
- Use EDI eligibility verification transactions available from your clearinghouse or practice management system
For more information or to sign up for NaviNet access, click here or call NaviNet Customer Support at 1-888-482-8057
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Ohio Department of Medicaid fraud warning
Criminals are targeting Medicaid recipients for sensitive, personal, and financial information. If your patient gets a call, text, or email about Medicaid benefits asking for a Social Security number, payment, bank, debit, or credit card information, advise your patient to not respond. They’re not from the State of Ohio or any agency. Instead, it should be reported to the Ohio Attorney General at 800-282-0515 or https://www.ohioprotects.org/.
Ohio Department of Medicaid is not approving any trading partner to submit EDI claims directly to the MCEs
Ohio Department of Medicaid (ODM) has determined that the direct submission of claims by trading partners (TP) to Managed Care Entities (MCE) is not needed and would create an inconsistent provider experience across MCEs. Click here to read the entire ODM memo.
Providers and/or trading partners experiencing EDI claim issues should contact ODMs Integrated Helpdesk (IHD) at 800-686-1516. Additional resources related to claims submission can be found on ODMs website here:
Important reminder: update addresses and affiliations in the Provider Network Management module
Please update and maintain all addresses and practitioner affiliations in the Provider Network Management (PNM) module on a regular basis to keep all information current. This information is required by the provider agreement.
The benefit of regularly maintaining current provider information in the PNM module is that providers do not have to update this information with each of the MCEs. ODM provides a daily file of all provider data to each MCE and requires them to use the most up‐to‐date information for billing and directory purposes. Click here to read the entire memo from ODM, learn what actions to take and find technical support.
Rendering Provider on Professional Claims Submissions
ODM is providing additional clarification relevant to EDI‐related claims submissions on or after February 1 concerning rendering providers. ODM will require one rendering provider per claim at the header level, rather than the detail level, for professional claims for both fee‐for‐service (FFS) and managed care recipients in order to ensure claims can be properly priced and paid. Click here for examples of claims submissions, an exception to this rule and additional guidance for FQHC/RHC providers.
Breast Milk Storage Bags
ODM is encouraging OB/GYNs to help spread the word that ODM covers breast milk storage bags. Each provider needs to put an order in the patient's record indicating they need breast milk storage bags so that the patient can order the bags from a durable medical equipment supplier. ODM appreciates your help in making sure our moms have what they need to ensure successful breastfeeding!
Details regarding pricing and limits for breast milk storage bags can be found on the DME (DMEPOS) fee schedule as well as the CPT and HCPCs Level II Procedure Code Changes fee schedule. Both of these fee schedules can be found on ODMs website.
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Do not send paper claims
The Next Generation of Ohio Medicaid program's guidelines require all claims to be submitted via the Electronic Data Exchange (EDI). If you have submitted a paper claim, you will be advised that your claim has not been processed and what your next steps should be. You can get started on our website with claims how-to's, quick guides, links and contact info.
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Claims submission and medical attachment with Change Healthcare |
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AmeriHealth Caritas Ohio is accepting Medical Attachments (unsolicited) via our preferred vendor Change Healthcare. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic Medical Attachment (275) submissions via payer ID: 84243. (Please note data fees may apply)
There are three ways the Medical Attachments can be submitted to the Change Healthcare clearinghouse. The acceptable supported formats are PDF, TIF, TIFF, JPEG, JPG, PNG, DOCX, RTF, XML, DOC, TXT, GIF and BMP.
- Batch — You may either connect to Change Healthcare directly or submit via your EDI clearing house.
- API via JSON — You may submit an attachment for a single claim.
- Portal — Individual providers can register at Change Healthcare to submit Medical Attachments.
AmeriHealth Caritas Ohio providers with a limited ability to submit claims through their hospital or project management system may benefit from a tool that Change Healthcare offers called ConnectCenter. There is no cost to providers to use ConnectCenter. To register for ConnectCenter, click here. If you need assistance with ConnectCenter, Change Healthcare customer support is available through online chat or by phone at 1-800-527-8133, option 2.
Key features are:
- Claims users do not need to choose between data entry of claims and upload of 837 files. All users may do both.
- Secondary and tertiary claims can be submitted
- Institutional claims are supported
- Claims created online are fully validated in real-time so that providers can correct them immediately
- Whether providers upload their claims or create them online, the claim reports are integrated with the claim correction screen for ease in follow-up
- Dashboard and work list views enables providers to streamline their billing to-do list
- Remittance Advice is automatically linked to provider's submitted claim, providing a comprehensive view of the status of their claim
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Are you an ACOH vision provider?
We have contracted with two optical laboratories to provide your patients (our members) with glasses: Robertson Optical and Classic Optical. You are required to order member glasses through one of these labs. A prior authorization (PA) is not required; however, you must confirm eligibility.
Classic Optical Laboratories
- The available frame choices are conveniently the same frames included in the Ohio Medicaid frame collection which many provider offices have
- Orders may be placed through the Classic Optical website directly
- Classic Optical will check the member’s eligibility in real-time prior to the order being placed
- If you have questions for Classic Optical, call 1-888-522-2020
Robertson Optical Laboratories
- All vision providers will be required to display the Medicaid frame kits provided by Robertson Optical
- Orders must be placed through the dedicated Robertson Optical portal
- The cost per frame kit is $200
- If you have questions for Robertson Optical Laboratories, they can be reached at: 1-800-922-5525
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Prior Authorizations
Did you know you can submit prior authorizations through the NaviNet portal? AmeriHealth Caritas Ohio created this tool to provide a higher auto-approval rate and quicker turnaround time compared to faxing the authorizations. There is also a report function that gives a status report allowing you to have visibility to all prior authorization requests you have submitted. We are happy to offer training or any assistance your team may need to transition to this process. Please reach out to your local Account Executive.
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Claims Payment Systemic Error (CPSE) Report
The Claims Payment Systemic Errors (CPSE) report is updated and posted on the ‘Alerts and Newsletter’ page monthly. AmeriHealth Caritas Ohio encourages you to review this log frequently and before contacting our Provider Services team. If after reviewing you still have additional questions, please feel free to reach out to Provider Services at 1-833-644-6001 and, as always, you can reach out to your local account executive. Click here to view the report.
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Ohio Pulsewrx Program for Continuous Glucose Monitoring
The Ohio Pulsewrx Program exclusively offers eligible households a high-quality smartphone compatible with FreeStyle Libre 2 and 3 via The Lifeline Wireless Program and Affordable Connectivity Program (ACP). Ohio Medicaid members receive a smartphone built to connect them with important contacts, health resources, and mobile apps for long-term connectivity and health & wellbeing. All Medicaid Members are eligible, including MyCare recipients.
Join the Pulsewrx Team to learn how Ohio Medicaid recipients can enroll in this free and important benefit. Pulsewrx will discuss the phone benefit, provide a website demo, and share best practices for successful enrollment.
The session will cover 20 minutes of content and 10 minutes of Q&A. Registration is required via the links below. All sessions provide identical content.
This training is hosted by Pulsewrx. Please reach out to contact@pulsewrx.com with any questions.
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Did you know?
If members must travel 30 miles or more from their home to receive covered healthcare services, AmeriHealth Caritas Ohio (ACOH) will provide transportation to and from the provider’s office. ACOH contracts with MTM for delivery of this non-emergency medical transportation (NEMT) coverage.
Transportation providers that are not contracted with MTM can join MTMs network and submit claims for ACOH members. To join MTMs NEMT network:
Transportation providers currently contracted with MTM needing support
- You may contact MTM at 1-888-597-1180
- Or contact your MTM vendor account manager directly
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Join us at a virtual new provider orientation session
AmeriHealth Caritas Ohio has added additional provider orientation sessions. Please see the dates below and join your personal account executives online via Zoom from 10 a.m. - 11 a.m.
May 16 - Click here to register
June 20 - Click here to register
July 18 - Click here to register
If you have attended an orientation session and have not completed the attestation, please click here to do so.
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Tell us a little bit about where you’re from.
I was born, raised and have lived in NW Ohio my entire life. My husband and I have three adult children. We have twin daughters and a son.
Everyone at AmeriHealth Caritas Ohio (ACOH) has a story about why they joined the team. What’s yours?
I was so intrigued by the culture here. I can 100% say that this organization lives by their mission and I am so proud to be part of this team and organization.
What drew you to this profession?
Bottom line- I enjoy helping people and I love to problem solve. I get to do both at AmeriHealth Caritas!
What do you like to do in your free time? Spend time with my family. My girls moved to Cleveland a year
Sara with her husband and family |
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ago, so we take a lot of day trips to see them. Thankfully my parents and sister live close by, so I spend a lot of time with them.
If you could have dinner with anyone in the world, dead or alive, who would it be? Why?
My Grandpa! I had a very special bond with him until he passed away in 2012. When I was younger I spent every Friday night at his house and he would watch me in the summer when school was out. We always lived in close proximity to one another, so when I got older and had kids he would come over twice a day and spend time with us. He was the best!!
What are two apps on your phone you CANNOT live without?
Hmmmm… probably TikTok and Facebook. TikTok because who can’t laugh for hours at some of those videos?!?! And Facebook because it is a great way to connect with friends and family who I don’t get to see on a regular basis.
Any interesting facts about yourself that you’d like to share?
Many, many moons ago I was a hair stylist. I keep my license because you just never know.
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Mental Health Awareness Month
Mental Health Awareness Month was established in 1949 to increase awareness of the importance of mental health and wellness in Americans’ lives and to celebrate recovery from mental illness. For the past 20 years, the Substance Abuse and Mental Health Services Administration (SAMHSA) has recognized Mental Health Awareness Month (MHAM) every May to increase awareness about the vital role mental health plays in our overall health and well-being.
Here are a few suggested strategies that you can use to maintain positive
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mental health. The key is to try them, see what works for you and put them into practice regularly.
- Enjoy nature
- Connect with family or friends
- Practice mindfulness
- Spend time with your pets
- Volunteer
- Join a support group
- Eat right
- Exercise
- Reduce or eliminate alcohol and other substance use
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CPC webinars from ODM
- Tuesday, June 6 - CPC Quarterly Webinar: Improve foster care supports for youth and tips on how to communicate effectively with local schools
- Tuesday, September 12 - CPC Quarterly Webinar: Enrollment in CPC and PNM
More information and register links here.
Improving Outcomes for People with Disabilities 2023 virtual roundtable
Ohio Association of Health Plans and Ohio Center for Autism and Low Incidence (OCALI) are hosting a series of virtual roundtables. This series provides attendees the opportunity to hear from and engage with national experts and local leaders and deepen their understanding of people with disabilities as a focus of population health. The one-hour roundtables include lived experience, didactic presentation, and opportunity for interaction. Each session is designed to both challenge your thinking and change your practice, providing you with tools and resources you can use immediately. Click here to register.
Webinar: Heart Health and the Science of Sleep
The Ohio Cardiovascular & Diabetes Health Collaborative is offering a Heart Health and the Science of Sleep webinar with CME credit offered. Objectives:
- Identify the cardiovascular implications of sleep conditions
- Screen patients at risk for sleep conditions
- Counsel patients on how to optimize sleep health
Sign up here. |
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