On June 21, ODM released a MITS Bits communication with an important update regarding Aetna’s use of practitioner modifiers for claims that replaces the BH MITS Bits dated June 15. The Ohio Council learned that Aetna’s practitioner modifier set up would create complications with claims payments across other MCOs and brought this issue to ODM and Aetna’s attention. We are grateful that they listened to our concerns and made this change. Going forward, Aetna will align the OhioRISE practitioner modifier requirements for outpatient and professional claims with those used in ODM’s fee-for-service program. We appreciate that many provider organizations were already working to implement the billing requirements previously communicated and this change may be frustrating given the many demands on your time. However, we are confident that this claims policy alignment across all MCOs, including Aetna/OhioRISE, was necessary now to support claims payment when OhioRISE is implemented on July 1.

Click here to read the complete MITS Bits from June 21.

• Questions for Aetna regarding OhioRISE claims may be submitted to the provider network mailbox: [email protected]
• Questions for ODM’s Office of Behavioral Health Policy may be submitted to: [email protected]
• General questions for ODM regarding OhioRISE may be submitted to: [email protected]