News for Ohio Medicaid Providers
By Department of Medicaid / November 27, 2024
Timely Filing Deadline Extended Through February 28, 2025
o ensure providers can continue to serve members to the best of your ability, the Ohio Department of Medicaid (ODM) is extending the timely filing deadline one final time through February 28, 2025.
ODM has resolved most claim submission concerns, resulting in a rejection rate of less than 1% for fee-for-service and managed care claims. However, approximately 2% of providers have contract issues preventing them from meeting the current timely filing deadline. Therefore, we are extending the timely filing deadline to make sure these impacts do not impede a provider’s ability to serve Medicaid patients.
In order to give providers time to submit any currently held claims, and for those remaining contract updates and affiliation relationships to be in place, ODM is extending the timely filing requirements, outlined in the Ohio Administrative Code rule 5160-1-19.
Please note, we will not be extending the timely filing deadline beyond February 28, 2025. We will resume normal operations starting March 1, 2025.
It is critical that all providers take two actions before March 1, 2025.
If you have received a denial for a contract or affiliation related issue, please review your Provider Network Management (PNM) data to make sure it is correct. If the PNM data is correct and you received a denial indicating a contract or an affiliation issue, please report this to the Integrated Helpdesk.
Providers should submit all currently held claims even if there is a chance the claims will be denied. If a data fix or system configuration is required to properly adjudicate the claim, ODM will be able to make these adjustments on all claims successfully received by the system even if it is past the standard timely filing deadline. Even if claims are denied due to data fix issues, we will be able to reprocess your claims as your claims will be in the system and will have met the timely filing deadline.
Beginning March 1, any claim not in the system that needs to be submitted for a timely filing exemption will be required to follow the medical claims review process by submitting the 6653 form. Submitting all claims before March 1 will avoid this additional manual work and time required to process them.
Submission Guidelines for Providers Who Submit Claims Via the Electronic Data Interchange:
Similar instructions are being sent to your trading partner. Please reach out to them to ensure the necessary information has been included on your submissions. Claims that are more than 365 days from the date of service submitted before March 1 must include the appropriate Delay Reason Code in the CLM 20 field. You should select the CLM 20 Delay Reason using the following guidance:
A – Delay Reason Code = 7 (Third Party Processing Delay): use this code if the claims could not be submitted through the system at all.
B – Delay Reason Code = 9 (Original Claim Rejected): use this code if the original claim was submitted, but it could not be processed through the Ohio Medicaid Enterprise system at that time.
Although ODM extended the timely filing requirements, claims submitted after the standard 365-day limit are still subject to post payment review. ODM may verify evidence of system submission issues, such as reviewing past IHD call logs to verify that providers attempted to troubleshoot their issue. If troubleshooting efforts are not evident, the claim payment may be reversed.
Managed care plans are being instructed to follow the dates outlined above. Exceptions beyond the outlined timely filing rules must follow the appropriate managed care appeals process.