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General Information For Medicaid Providers

MHTL 3334-11-07 (Re-issuance of the Electronic Billing Instructions Provider Manual)

Medicaid Handbook Transmittal Letter (MHTL) No. 3334-11-07

August 3, 2011

TO:              Eligible Medicaid Providers

Chief Executive Officers, Managed Care Plans (MCPs)

Directors, County Departments of Job and Family Services

FROM:         Michael B. Colbert, Director

SUBJECT:    Re-issuance of the Electronic Billing Instructions Provider Manual

Notice

In August 2011, the Ohio Department of Job and Family Services (ODJFS) will replace its nearly 30-year-old Medicaid Management Information System (MMIS) with a new web-based Medicaid Information Technology System (MITS). MITS is designed to have greater flexibility, adaptability, and functionality for providers. Provisions of the Ohio Administrative Code (OAC) will also be more fully integrated into the MITS structure; as a result, when MITS is implemented, claims will be processed and paid more consistently in accordance with Medicaid rules. This MHTL is an advisory notice to let you know about some of the changes that are being made as a result of MITS implementation. No action on your part is required.

Several forms, instruction sheets, and transmittal letters related to the submission of claims have been stored in the 'Billing Instructions' manual within the 'Ohio Health Plans - Provider' collection on the ODJFS electronic manuals ("eManuals") web page. These documents deal mostly with processes used in MMIS. Some of the items are outdated, and implementation of MITS will render others obsolete. Documents that are no longer relevant will be removed on or before the MITS "Go-Live" date of August 2, 2011, and remaining items will be updated as necessary over the coming months.

The following items will be removed from the 'Billing Instructions' manual:

·                 Paper Claims Grid May 2010

·                 General Billing Information for ODJFS Paper Claims - Paper Claims Submission Address List

·                 JFS 03612 Dental Prior Authorization Form

·                 JFS 03612 Dental Prior Authorization Instructions

·                 JFS 06780 Medicaid Claim Billing Form

·                 JFS 06780 Part B and C Crossover Billing Instructions for Paper Claims

·                 ODJFS Dental Instructions for Paper Claims

·                 Medical Assistance Letters

·                 MAL 522, "Guidance on the Implementation of Employee Education about False Claims Recovery as provided in MAL 516" [link]

·                 MAL 516, "Employee Education About False Claims Recovery" [link]

·                 MAL 466, "Professional Billing Instructions for Medicare HMO Crossover Claims"

·                 MAL 455, "JFS 06653 Medical Claim Review Request Form"

·                 MAL 396-A, "Revised ADA Claim Form Billing Instructions"

·                 MAL 396, "ADA Claim Form Update, Effective August 1, 2001"

·                 MAL 378, "Claim Credit Reversal Form ODHS 6768"

The following items will be updated or added:

·                 The link to the EDI Companion Guides web page will be reestablished, and links to individual Companion Guides will be included.

·                 Three new Web Portal billing guides for professional, institutional, and dental claims are being developed and will be added. These billing guides will offer practical suggestions and tips to ensure that claims can be submitted and processed successfully in the MITS Web Portal.

·                 Because submission of hard-copy claims will still be permitted in a very few circumstances, billing instructions for paper claim forms will be maintained:

·                 ODJFS Instructions for Completing the CMS-1500 Paper Claim Form (updated)

·                 ODJFS Instructions for Completing the UB-04 Paper Claim Form for Hospitals (updated)

·                 ODJFS Instructions for Completing the UB-04 Paper Claim Form for Freestanding Dialysis Clinics (updated)

·                 ODJFS Instructions for Completing the ADA 2006 Paper Claim Form (updated)

The structure of the 'Billing Instructions' manual will be modified. Other documents may be added in the future as they are needed.

Access to Rules and Related Material

The main ODJFS web page includes links to valuable information about its services and programs; the address is http://www.jfs.ohio.gov . The web page of the Office of Ohio Health Plans (Medicaid) may be accessed through the ODJFS main page or directly at http://www.jfs.ohio.gov/ohp/ .

In addition to the 'Billing Instructions' manual, an abundance of information for Medicaid providers is available on the eManuals web page, http://emanuals.odjfs.state.oh.us/emanuals/.

From the eManuals page, providers may view documents online by following these steps:

(1)      Select the 'Ohio Health Plans - Provider' collection.

(2)      Select the appropriate service provider type or manual.

(3)      Select the desired chapter or document type.

(4)      Select the desired item from the 'Table of Contents' pull-down menu.

The Legal/Policy Central - Calendar site, http://www.odjfs.state.oh.us/lpc/calendar/ , is a quick reference for finding documents that have recently been published. This site also provides a link to a listing of ODJFS manual transmittal letters, http://www.odjfs.state.oh.us/lpc/mtl/ . The listing is categorized by letter number and subject, and a link is provided to each easy-print (PDF) document.

To receive automatic electronic notification when new Medicaid transmittal letters are published, sign up for the ODJFS e‑mail subscription service at http://www.odjfs.state.oh.us/subscribe/ .

Additional Information

Questions pertaining to this letter should be addressed to:

Ohio Department of Job and Family Services

Office of Ohio Health Plans, Bureau of Provider Services

P.O. Box 1461

Columbus, OH 43216-1461

Telephone (800) 686-1516

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