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Our goals are to ensure fiscal integrity and appropriate medical care; provider integrity and quality assurance; statewide medical assistance programs; utilization of quality medical services; and that medically necessary services are delivered to Ohio's Medicaid population.
The three sections of the Bureau:
Claims Processing
The Claims Processing section is responsible for the processing of the hard copy Medicaid claims and attachments from Medicaid providers each year. The section is divided into three work units: Claims Control, Claims Retrieval and Exam Entry/Suspense Resolution (EE/SR). The units are charged with ensuring that hard copy claims, received for processing, are disbursed to contracted entities or kept in house for processing; storing hard copies of claims, then destroying them after retention limitations are reached; edits, labels and files microfilm and microfiche; responds to requests for paper copies of claims or remittance advices; data entry and resolution of suspended claims for adjudication.
Claims Services
The Claims Services sections primary responsibility is for reviewing and making adjustments to previously paid claims to Medicaid and Long-Term Care providers. They also reissue Medicaid warrants, process provider liens and garnishments and resolve billing errors and problems.
Provider Services Section
The Provider Network Management section is the primary liaison between the medical provider community and the Medicaid fee-for-service program. The Provider Assistance unit answers telephone inquiries on billing, claims payment status, policy and coding. The Ombudsmen & MAC Technical Assistance unit reviews hard copy problematic claims and furnishes claims resolution assistance and training to the provider community. The Provider Enrollment unit is responsible for enrolling providers and EDI trading partners in the Medicaid program. |