Ohio Department of Medicaid (ODM) is in the process of modernizing its management information systems. This modernization roadmap was developed in accordance with Centers for Medicare and Medicaid Services (CMS) guidance and includes a transition to a modular system called the Ohio Medicaid Enterprise System (OMES) that will support ODM in meeting several modernization goals.
As a part of this roadmap, new, updated functionality is being built into OMES rather than Medicaid Information Technology System (MITS). With the full implementation of the OMES, the new Fiscal Intermediary (FI) will replace the claims and financial subsystems of MITS.
As a result, on February 1, the Fiscal Intermediary (FI) began processing of claims via the Electronic Data Interchange (EDI). Fee-for-service claims submitted to the EDI are processed, adjudicated, and paid by the FI. Managed care claims submitted via the EDI will be routed to the MCOs for processing, adjudication, and payment. Please note, these changes do not apply to MyCare. MyCare providers should continue to submit claims and prior authorizations directly to the appropriate payer, either the MyCare managed care plan or Medicare. Additional FI functionality will come later related to portal claims submitted via the Provider Network Management (PNM) portal. Providers, trading partners, and managed care entities will not directly interact with the FI.