Potential Action Required to Avoid Medicaid Termination

Potential Action Required to Avoid Medicaid Termination - PNM SSN Verification

We wanted to ensure Ohio Council member organizations are aware that the Ohio Department of Medicaid (ODM) will be validating provider organization information in the PNM against the Social Security Administration Death Master File this weekend. Several hundred organizations, including behavioral health providers, were terminated in February the last time this was conducted. ODM has contacted the previously impacted organizations that have yet to make the required updates in the PNM since February. ODM called and sent the below email to organizations that must take action TODAY or your organization will be terminated from Medicaid and you will be required to submit a new Medicaid provider enrollment application for your organization with a required site visit. This process can take up to 90 days or longer.

If your organization received a call from ODM or the email below, ACT NOW and follow the steps outlined below to avoid termination of your Medicaid provider agreement. ODM will not be reinstating terminated organizations as they did in February. Please note, if you completed the process below and your organization is in a pending or submitted status in the PNM, you will not be terminated. If your organization was not terminated in February and/or was not contacted by ODM this week, there is no action necessary. However, providers should ensure they have a process to updated information about ownership, control interest, and managing employees in the PNM for their organization as this validation will be conducted monthly.

Action Required: Update Your PNM SSN/TIN Owner Information To Avoid Termination

Attention Medicaid provider,

All Ohio Medicaid provider organizations must disclose and maintain information about ownership, control interest, and managing employees in the Provider Network Management (PNM) module as part of their Medicaid Provider Agreement. The Ohio Department of Medicaid is required to verify that individuals and organizations disclosed for this purpose are screened against several federal exclusion databases. The PNM module automatically runs these checks on a monthly basis.

If you are receiving this email, our records show that one of your organization’s disclosed owners or managing employees is triggering a match on the Social Security Death Masterfile, a federal exclusion database. You must take immediate action to avoid termination.

Required action:

Log into the PNM and complete an update.
Medicaid-only providers should choose “Begin Reapplication” or “Begin Revalidation.”
Providers with Department of Developmental Disabilities contracts need to choose “Begin DODD Enrollment.”
Check for the following common issues:

The person listed as an owner or managing employee is deceased and the owner or managing employee record needs to be end-dated on the provider's application.
A person provided an employee identification number in lieu of a social security number. State and federal regulations require that individuals disclose their social security number.
A person’s social security number is mistyped.

Note: If you submitted an update to this information that Ohio Medicaid is currently reviewing, you do not need to take any further action.

For more information:

Access the Updating or Adding Owner Information Quick Reference Guide for step-by-step instructions on how to update your provider information in the PNM. For technical support or assistance, contact Ohio Medicaid’s Integrated Helpdesk (IHD) at 800-686-1516 and follow the prompts for provider enrollment (option two, option two) or email [email protected]. Representatives are available Monday-Friday, 8 a.m.-4:30 p.m. Eastern time.