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Ohio Department of Medicaid awards fiscal intermediary contract to Gainwell Technologies

For immediate release: December 8, 2020

Kevin R. Walter, Press Secretary, Ohio Department of Medicaid
614-752-3688 ǀ kevin.walter@medicaid.ohio.gov

Lisa Lawless, Communications Director, Ohio Department of Medicaid
614-752-3567 ǀ elizabeth.lawless@medicaid.ohio.gov

Ohio Department of Medicaid Awards Fiscal Intermediary Contract to Gainwell Technologies

COLUMBUS, Ohio — The Ohio Department of Medicaid (ODM) awards its fiscal intermediary (FI) service contract to Gainwell Technologies, taking another important step forward in delivering a person-centric next generation managed care program to Ohio.

The fiscal intermediary is a part of a larger effort to modernize ODM’s management information systems, developed in accordance with the Centers for Medicare and Medicaid Services (CMS) guidance. Adopting CMS’ modernization guidance saves the state 90% of the design and build costs, and 75% of the maintenance expenses.

The module will serve as a single clearinghouse for all provider claims and prior authorization requests, validating transactions and routing requests to the appropriate managed care organization (MCO) for resolution and reimbursement. In addition to streamlining the claims process, the fiscal intermediary will strengthen ODM’s ability to assess compliance with Medicaid managed care regulations, review encounter data, and track performance measures.

“Today claims data handled exclusively by managed care organizations takes between three and six months to reach ODM health data analysts,” said Maureen Corcoran, director of ODM. “The fiscal intermediary will provide access to these critical health care transactions in real time, enabling us to adjust programs, policies, or services more efficiently.”

For providers, the fiscal intermediary will:

  • Lighten the administrative load: Providers will submit and monitor all claims and prior authorization requests through a single system vs. having to manage these transactions with each individual MCO.
  • Streamline and standardize the prior authorization process: Ohio Medicaid will require MCOs to develop necessary electronic exchanges to assist with coordinating service authorization requests through ODM's fiscal intermediary.
  • Provide timely updates on claims and prior authorization status: Providers will have an opportunity to correct claims errors that lead to denials and expedite the review and reimbursement cycle.

As the selected FI vendor, Gainwell brings more than 50 years of experience supporting state Medicaid agencies across the country. The company will implement the fiscal intermediary component of ODM’s technology modernization strategy, including the configuration, implementation, operation, and maintenance of the solution.