On July 20, the Ohio Department of Medicaid (ODM) hosted a webinar outlining the next two phases of the staggered implementation of the Next Generation of Medicaid. The webinar recording and PowerPoint will be made available here in the coming weeks. The Next Generation Medicaid strategy includes the implementation of the Ohio Medicaid Enterprise System (OMES) which will replace most functionalities in MITS. OMES includes several modules including the Provider Network Management (PNM) module, the Fiscal Intermediary (FI), and the Single Pharmacy Benefit Manager (SPBM). After all phases of the Next Generation of Medicaid are implemented, providers will no longer utilize MITS for provider enrollment, claims submission, or prior authorization.

Phase 2 of the Next Generation implementation will be effective October 1, 2022, and will include the launch of the Provider Network Management Module (PNM) for provider enrollment and credentialing and the Single Pharmacy Benefit Manager (SPBM). The PNM is the new Medicaid provider enrollment and data management system that will replace MITS. However, during the second phase of implementation providers will continue to be directed to MITS for fee-for-service claims submission and prior authorizations, and to check Medicaid member eligibility.

Phase 3 of the staggered implementation will be effective December 1 and will include the launch of the Fiscal Intermediary and the seven next generation managed care plans. The Fiscal Intermediary (FI) will simplify and streamline the provider process for submitting Medicaid claims and prior authorizations. The FI will process Medicaid fee-for-service claims and prior authorizations and route managed care claims and prior authorizations to the managed care plan for final adjudication and payment. Only authorized trading partners will be able to exchange EDI transactions with the FI. Organizations using a clearinghouse to submit claims should check with their trading partner/clearinghouse to ensure they are engaged with ODM on this transition and prepared for the changes. Organizations who wish to become their own trading partner will be able to enroll after the Stage 3 go-live. Additional details for training on Phase 3 are forthcoming.