New Medicaid Information Technology System (MITS) Coming in December 2010
In December 2010, Ohio Medicaid will replace its 20+ year old Medicaid Management Information System (MMIS) for claims
processing with the enhanced Ohio Medicaid Information Technology System (MITS). Also included as part of MITS is the
new enhanced MITS Web Portal. Progress continues on the development and testing of this new system, which will bring
Ohio Medicaid into the 21st century! With state-of-the-art technology and business processes, claims will be processed
accurately, timely and in "real time" for providers and other stakeholders.
What does this mean for providers and stakeholders, and what changes are in store for you?
Here is a high-level preview of some of the changes that will take place when MITS goes live in December 2010:
The new enhanced MITS Web Portal will:
• Allow claims submission for professional, institutional and dental claims;
• Process online provider enrollment applications;
• Allow Web submission of prior authorization requests; and
• Allow providers to conduct claims inquiry, adjustments, and re-submissions online.
Implementation of newer versions of paper claim forms:
• Change to the UB04 from the UB92.
• Change to the ADA 2006 from the ADA 2000.
Utilization of complete diagnosis (ICD-9) codes:
• The complete ICD-9 code set will be used to provide the highest specificity for the diagnosis.
Addition of a clinical claims editor:
• Claims processing will include the review and editing of diagnostic and medical procedure codes.
• Health care industry standard guidelines will be used to prevent inappropriate payment for duplicate, re-bundled,
mutually exclusive, and incidental and pre/post-operative care.
Formatting changes and updated look for remittance advices:
• Providers will bill with HIPAA adjustment and reason codes (ARC).
• The TCN (transaction control number) assigned to claims in adjudication will be referred to as the ICN (interchange
control number).
What you need to know to start planning for December 2010
• Begin discussion with your leadership and staff about the changes that will be coming.
• Work with the Provider Enrollment Unit to update your group membership, including any additions and separations of
Medicaid-enrolled providers. Questions? Contact the ODJFS Medicaid Provider Enrollment Unit at 1-800-686-1516.
• Bookmark the MITS Web site for updates and detailed information on the many changes and enhancements at http:
//jfs.ohio.gov/mits/info.stm.
• If you bill on paper, plan for the conversion to new paper forms.
o Institutional providers currently using the UB92 will use the UB04.
o Dental providers currently using the ADA version 2000 will use the ADA version 2006.
o Professional providers will continue to use the CMS 1500.
• Start a conversation now with your software vendors so they are aware of the changes that will be up coming.
When will providers and other stakeholders be trained?
• An extensive statewide outreach and training strategy is in development, with training to begin this fall.
• Watch for news on the MITS Web site, http://jfs.ohio.gov/mits/info.stm, about training and registration, and make
plans for you and your staff to attend a seminar or webinar.
If you are an ODJFS trading partner,
• The 835 EDI remittance advice will continue to be sent once a week.
• Companion guides for the 835, as well as other EDI transactions, will be made available online in the near future.
• For all of the latest updates and news, go to http://jfs.ohio.gov/OHP/tradingpartners/info.stm.
Keep informed and keep in touch
Again, this is a high-level preview of some of the changes that will take place when Go-Live occurs in December 2010. We
appreciate all you do to provide quality services to Ohio’s Medicaid consumers! ODJFS is committed to working closely with
you during the transition and successful implementation of our new MITS. For the most up-to-date information about the
MITS Web Portal, as well as information on functionality, tools and how the replacement system will impact you as a
provider, log on to http://jfs.ohio.gov/mits/info.stm.
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New Provider Enrollment Process
Effective June 1st, 2009, CareStar will no longer be processing enrollment applications for Ohio Home Care Program
providers. If you know anyone who will be requesting an application to become a provider after June 1st, please inform
them of our new process below.
The new provider enrollment process is web-based, and provides printable fact sheets and applications for each provider
type. Click here for Provider Enrollment Online
NOTE: CareStar Enrollment staff will continue to process any applications received prior to June 1st, and will be available
for questions and technical support through July 1st, 2009.
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May 5, 2009
It's that time again! We are being asked to take a preview of the Rules being considered; which will affect most of our
livelihoods.
Please click on the Rules link, and scroll down to :: Ohio Health Plans :: Providers :: Community Services Policy and take
the opportunity to "Comment" on these proposed Rules for the Waiver Program. Our input makes a difference!
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March 2, 2009 3% Increase Raise Update
Dear Ohio Independent Providers:
Many have asked, "Where's the second 3% increase raise; which was to begin Jan. 2009?" Please see the following
update from the Ohio Council for Home Care: (whom by the way have been representing us at these
hearings).
Ohio Council's Fight for 3% Increase for Medicaid for FY2009 Will Not HappenFollowing his testimony, Medicaid Director
Corlett answered numerous questions posed by the members of the House Finance and Appropriations Committee. A line
of questioning from Rep. Sears (R-Toledo), really interested Ohio Council Executive Director, and Communications
Specialist who were both in the audience during this testimony.
Following a detailed explanation of why nursing facilities should receive a rate increase and not be faced with higher bed
taxes, Rep. Sears asked Dir. Corlett to respond.
Citing information from the Ecomonic Study conducted by the Ohio Council for Home Care, Director Corlett responded that
the amount of money being dispursed to nursing facilities versus home and community based care was skewed in a
direction that he would like to see shifted. He described how 65% of SNF are being paid for by Medicaid. He spoke of the
importance of examining what community based services could be provided outside the walls of nursing facilities, and that
some nursing facilities are now looking to provide those community care services.
Rep. Sears responded that it is absolutely right to provide more home and community based services. She then began to
question the PASSPORT reimbursement increases. She said that the amount that was increased was small and that it was
impossible to have home and community based services remain cost effective if they are not paid in a timely manner and in
a manner that will provide them the monetary support to continue.
Director Corlett responded that through this budget there will be full funding the PASSPORT program, and he then
deferred all other PASSPORT specific questions to Ohio Department of Aging Director Riley.
Rep. Sears then asked a question regarding the hard fought for 3% increase that Ohio Council for Home Care was able to
secure in the last biennium budget (HB 119). After detailing that Medicaid providers were to receive their first three percent
increase on January 1st, 2008 and the second increase on January 1st, 2009, Rep. Sears then questioned that by having
the first increase delayed until July 1st, of 2008, would we assume that the second increase should be given on June 30th,
2009.
Dir. Corlett explained that the three percent increase was the first increase to have been given in 8 years (while for home
care providers it had been 10 years). He further explained that this budget bill does not assume the second three precent
increase will happen.
Rep. Sears followed up by asking that if this second increase does not happen then it can be assumed that the desires of
the Ohio General Assembly in HB 119 were not acknowledged. Essentially the Medicaid Director would not be doing what
was said under the previous biennium bill.
Director Corlett responded, "The resources simply aren't there."
SOURCE: Ohio Council for Home Care (Newsletter)
Independent Provider Members of the OCHC received the full version of this newsletter.
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February 23, 2009 Update from the OHCP
Unauthorized Background Checks
Non-Agency Providers (RN's, LPN's and PCA's) are receiving background check notifications that
were not authorized by the Ohio Department of Job and Family Services (ODJFS). Disregard
these unauthorized notifications.
You should only comply with the background check requirement sent from ODJFS in
letter-form. No other entity has the authority to notify or request this annual requirement.
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December 17, 2008: Provider Rule Change
Time-Limited Provider Agreements/Re-enrollments
House Bill 119 Provider Agreement Changes;
House Bill 119 Provider Agreement Changes
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July 18, 2008: Medicaid Providers now able to
submit claims online. Medicaid Provider Portal
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