During our two Requests for Information (RFIs), the Ohio Department of Medicaid (ODM) received feedback underlining the need to streamline and simplify administrative tasks. One component of our response to address these pain points in the future Ohio Medicaid managed care program is implementation of a Fiscal Intermediary.
The Fiscal Intermediary will serve as a single point of entry for all provider claims and prior authorization requests. It will facilitate processing of and transitioning claims and requests to Ohio Medicaid’s future managed care plans as well as receive updates back from those organizations and be able to convey these to providers, making the process more transparent and efficient. The Fiscal Intermediary will also provide ODM with greater insight into claims and prior authorizations requests, allowing us to more effectively identify and address trends.
Fiscal Intermediary Summary
The Fiscal Intermediary is a part of a larger effort to modernize ODM’s management information systems. This modernization roadmap, developed in accordance with the Centers for Medicare and Medicaid Services (CMS) guidance, 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, updated and new functionality - such as Fiscal Intermediary - is being built into OMES rather than MITS.
In December 2020, ODM awarded the Fiscal Intermediary contract to Gainwell Technologies. Click here to read the full press release.