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Fiscal Intermediary

Fiscal Intermediary

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. 

ODM has reviewed the timeline needed to thoroughly design, develop, and test the system functionality needed to support the Fiscal Intermediary and is projected to deploy critical capabilities on July 1, 2022. Much of the functionality available to providers today in the MITS portal will continue with PNM module along with several improvements.

Fiscal Intermediary July 1, 2022 Capabilities

  • One Door for Prior Authorization Submissions (whether PNM or EDI) for all lines of business*
  • One Door for Claims Submissions (whether PNM or EDI) for all lines of business*
  • One Door for Recipient Eligibility Look-Up (whether PNM, EDI, or IVR) for all lines of business*
  • Additional functionality that exists in MITS today that will continue in PNM in the future:
    • Cost Report Submission
    • Ability to upload attachments for Prior Authorizations and Claims

*Refers to fee-for-service and managed care / OhioRISE. MyCare claims and prior authorizations will not be coming in Medicaid’s front door. Providers will continue to submit those claims and prior authorizations to the MyCare managed care plans.

Future PNM Capabilities (Post Go-Live)

  • Med Chat
  • Ability to print 1099s
  • W9 will not have a fillable pdf online until after Go Live
  • Ability to have more than one (1) Administrator (MITS only allows one Administrator today)
  • New Projects:
    • Doula
    • Baby/Mother Dyad
    • Welcome Home Postpartum Visits
    • Cost avoidance for Medicaid Opioid Treatment Programs
    • Add new Provider type to support new service under the SRS program
    • ABA for additional provider types
    • Timely Claim Filing Edit Modification
    • Aligning Coverage of FQHC/RHC BH Services w/BH Redesign
    • Allowing FQHCs/RHCs to Submit All Claims Under One NPI

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.