Frequently Asked Questions
Common questions and examples
Provider - Billing
Importance of Billing
This section is intended to help you provide the information necessary to exchange billing documents with the Ohio Home Care Program (Ohiohcp) so that you may reimbursed for your work.
New Medicaid Billing System:
Free Training Webinar Online!
The new Medicaid Information Technology System (MITS) will soon replace the current Medicaid billing system (its Go Live date has been delayed stay tuned for an exact date). We strongly encourage you to view the MITS Training presentation to learn how to use the system before it goes live. You can now view the MITS web page and presentation by clicking the link below.
Click to view MITS website & webinar
Billing the State
There are generally two ways in which to exchange bills with the
State of Ohio for services rendered in the Ohiohcp. They are:
Choosing this option means that you are generating and mailing your invoices directly to the State.
ODJFS has announced an implementation date for the new CMS 1500 form, version 08/05. Beginning with claims submitted on May 27, 2007, all providers who submit claims directly to Medicaid on a 1500 may use either form until further notice. The billing instructions for the old form have been revised and are effective with claims submitted on or after May 27, 2007. Revisions to the old form instructions appear in red.
Attached, you will also find the revised CMS 1500 billing instructions providers using the new 08/05 version of the CMS 1500 are to follow. NOTE: The new form can be used as of 5/27/07 regardless of date of service. The change has no impact on providers who utilize EDI vendors, with the exception of reporting NPI's for those who are required to obtain one.
Regardless of the form used, any provider who is required to use an NPI must begin using it on claims submitted on or after May 27, 2007. This applies to paper claims and EDI claims. Failure to follow the new instructions (either form) may result in claim denials or incorrect payment.
ODJFS no longer mails Medical Assistance Letters and updated program information to providers. Updates and new information is only available on-line and providers are responsible for checking for updates on their own
Instructions for Completing the New CMS 1500 08/05 NEW FORM
Instructions for Completing the New CMS 1500 08/05 OLD FORM
CMS 1500 HEALTH INSURANCE CLAIM FORM
Paper Claim Grid
Choosing this option means that you are contracting with a person or company (authorized trading partners) to submit your invoices electronically to Medicaid.
Authorized Trading Partners
Frequently Asked Questions
Why must providers possess a copy of the All Services Plan (ASP)?
The ASP authorizes the service units (hours) providers can be reimbursed for and may specify the schedule of visits.
What is Overpayment?
When a provider has billed for more units of service than the ASP.
What is a Notice of Operational Deficiency (NOD)?
ODJFS sends a Notice of Operational Deficiency (NOD) to a provider to make them
aware of an alleged violation. One example is billing more service than is authorized on the All Services Plan.
What is a Corrective Action Plan?
A Corrective Action Plan is the written response from the you, Medicaid home care provider, to a Notice of Operational Deficiency (NOD).
What are some examples of Provider monitoring in regards to billing?
Provider Monitoring Compliance and Provider Billing Elements are available on the Ohio Health Plans website.
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