Register Now for Medicaid's MITS Training

With Ohio's new Medicaid Information Technology System's (MITS) implementation coming in December 2010, there are several steps to prepare for Go Live!  Most importantly, the OOA urges all members to register for MITS Provider Training.  There are various training sessions throughout the state as well as online sessions available. 

For more information and to register for training visit http://www.seeuthere.com/hp/Ohio_MITS_Training_Workshops.  

National Provider Identifier (NPI) — Need it? Get it! Have it? Use it!

Medical practitioners and other "typical" health care providers are required to have and use a National Provider Identifier (NPI) for all medical claims submissions. Currently, the Ohio Department of Job and Family Services (ODJFS) requires claims to include the provider's 10-digit NPI in the rendering provider and billing (pay-to) provider fields. When the new Ohio Medicaid Information Technology System (MITS) goes live, a typicalprovider must also use NPIs in any claim field that requires provider identification (e.g., referring provider, attending provider, operating provider). Claims submitted without an NPI, as well as claims submitted with thegeneric provider ID number 9111115, will be denied.

On the other hand, certain providers that furnish only non-health-care services are not required to obtain an NPI. Such "atypical" providers can continue to submit claims with only their 7-digit "legacy" Medicaid provider ID number. An atypical provider that has obtained a NPI, however, must use it on claims.

Rendering Provider, Billing Provider — Make the Connection!

As it processes professional claims, MITS looks for a relationship—a link—between the billing provider and the rendering provider. This link is important for Medicaid providers that may submit claims on behalf of their affiliated practitioners, such as hospitals, ambulatory surgery centers (ASCs), hospices and group practices. Therefore, it is essential that you report to ODJFS all practitioners enrolled as Ohio Medicaid providers who are affiliated with your facility or professional medical or dental group. Any claims submitted on behalf ofpractitioners whose affiliation is not known in MITS will be denied.

To record or update practitioner affiliations with a hospital, ASC, hospice or professional medical or dental group, complete form JFS 06777, Group Practice Provider Information, which can be obtained at the ODJFS Forms Central Web site, www.odjfs.state.oh.us/forms/inter.asp. Submit the form in one of three ways:

1. Mail it to ODJFS Provider Enrollment Unit, P.O. Box 1461, Columbus, OH 43216-1461
2. Fax it to 1-614-995-5904
3. Attach it to an e-mail message addressed to: Medicaid_provider_update@jfs.ohio.gov, with the subject line “JFS 06777, Group Practice Provider Information." 

The Web Portal — Go online and open the door into MITS

After MITS goes live, many claims and forms will no longer be accepted on paper. Some documents, such as prior authorization requests, will be accepted only through the MITS Web Portal. As a Medicaid provider, you will need to have computer access and an Internet connection to access the Web Portal. If you do not currently have a high-speed connection, then you should consider getting one. Most dialup modems cannot readily accommodate the size and number of files that may be regularly submitted via the Web Portal. Many multi-function printers today include a scanning function, are easy to use, and have come down in price in recent years. You will also need to have processes in place for safeguarding protected health information.

Other MITS-Related Changes — Check out these great new features that are sure to enhance your claims-processing experience.

• The Web Portal will be required for provider enrollment (or reenrollment), prior authorization, submission of crossover claims and claims with third-party insurance, and claims adjustments. Paper documentation for these functions will be returned unprocessed.
• ODJFS will be implementing McKesson ClaimCheck, an auditing tool that reviews Medicaid laboratory claims and other professional claims to control improper coding and prevent inappropriate payment for duplicate, unbundled, mutually exclusive, incidental or pre-/post-operative care.
• MITS will enforce the correct use of national codes. In particular, the system will check the length of ICD-9 diagnosis codes and ICD-9 procedure codes. For example, if a claim includes a three-digit diagnosis code and the specification in the ICD-9 calls for four digits, then the claim will be denied. This code-checking has always been applied to claims submitted by hospitals, but it will be new for other providers submitting claims with the ICD-9 code set.
• Providers will be required to use national Health Care Services Decision Reason Codes on all claims involving coordination of benefits. ODJFS will no longer accept "local-level other-source codes" on claims as a valid explanation of why a primary payer denied a claim or paid less than billed charges.
• Place-of-service restrictions on certain procedures will be enforced. A claim that formerly was paid could now be denied if the service setting is not covered for the procedure.
• Providers will be able to submit, adjust and check claims; access remittance advices; and verify consumer eligibility through the Web Portal.

Additional HIPAA-compliant modifiers (for example, indicating left side, right side, separate evaluation and management, digit number, or surgical site) will be allowed on claims for professional services. These modifiers will be listed in appendices to the applicable rules in the Ohio Administrative Code, along with information on when to use them. 

Click here for a MITS Provider Association Presentation PDF.  This document  provides a general overview of the enhancements and changes with MITS. 

Also, check http://www.jfs.ohio.gov/mits/index.stm frequently to stay up to date with MITS.