Frequently Asked Questions
Learn more about MITS in the Frequently Asked Questions. New information is identified with after the question. Periodically check this Web site for FAQ updates and other information regarding the MITS implementation. Don't see what you need? Submit your question to MITS_FAQs@jfs.ohio.gov for possible inclusion in future FAQ updates.
What is MITS?
Ohio’s Medicaid Information Technology System (MITS) is a strategic project to replace Ohio’s legacy Medicaid Management Information System (MMIS). Implementation of MITS will provide the Ohio Medicaid Program with a technologically advanced MMIS that is better aligned with Federal guidelines for the Medicaid Information Technology Architecture (MITA) architectural framework and that better positions ODJFS/OHP to more effectively respond to the changing face of Medicaid as a result of MITA and Health Care Reform. MITS will not only replace the MMIS but will also introduce efficiencies to the Medicaid Program through automation and transformation of existing business processes that rely on paper and that are labor intensive. The MITS project will require ODJFS to re-engineer many business processes and redesign its organization in order to maximize the capabilities of the new technology. These improvements will help facilitate timely and accurate claims processing by offering near real time data to providers and other stakeholders. The new MITS application will also offer enhanced decision support to ODJFS and sister state agencies responsible for administering the Ohio Medicaid program and the State Children’s Health Insurance Program (SCHIP).
ODJFS looks forward to the implementation of this system and the far reaching positive impact it will have on Medicaid consumers and providers as well as other key stakeholders.
Why is ODJFS Developing MITS to Replace the Current MMIS?
The key business driver for the implementation of MITS is the need to replace Ohio’s over 20 year old legacy MMIS with a new system capable of more rapidly implementing program and policy changes resulting from state and federal mandates. Another major driver for the MITS implementation is the need to bring efficiencies to ODJFS/OHP operational activities through automation of business processes that are labor and paper intensive, allowing agency staff to spend more time on service delivery related activities focused on providers and consumers . In short, Ohio’s current MMIS does not meet Ohio’s evolving business needs and must be replaced with updated and more robust technology. Developing and implementing MITS will bring the opportunity to improve operations, and offer streamlined functionality for Managed Care Plans (MCPs), Medicaid providers, and consumers. MITS will provide a secure web site that will offer self service information and support through an array of automated business solutions.
The current MMIS is a mainframe-based (legacy) system which does not support the web-based and rules-driven functionality needed to effectively support the increasing demands placed on Ohio’s Medicaid program. In addition, the existing MMIS was not designed to meet the current capacity of processing 77 million health care claims annually for over two million Ohioans enrolled in Ohio Medicaid. Along with the age and limited capacity of the current MMIS, Ohio Medicaid needs a management information system that can quickly respond to changes in Federal and State law, and the requirements of Federal mandates such as the Health Insurance Portability and Accountability Act (HIPAA).
The MITS project will require ODJFS to re-engineer many business processes and redesign its organization in order to maximize the capabilities of the new technology. These improvements will help facilitate timely and accurate claims processing by offering near real time data to providers and other stakeholders. The new MITS will also offer enhanced decision support to ODJFS and sister state agencies responsible for administering the Ohio Medicaid program and the State Children’s Health Insurance Program (SCHIP).
What’s the history of ODJFS’s planning for MITS?
In June 2004, the Centers for Medicare and Medicaid Services (CMS) approved Ohio’s Advanced Planning Document for the new Medicaid system and selected Ohio as an early adopter state for the MITA initiative which is intended to foster integrated business and information technology transformation among all state Medicaid agencies and improve the national administration of the Medicaid Program. For more information on MITA, see below or visit: http://www.cms.hhs.gov/MedicaidInfoTechArch/.
Ohio chose to name its MMIS replacement project the Medicaid Information Technology System or MITS. During 2005, ODJFS conducted comprehensive business, technical, integration, and data conversion joint application design (JAD) requirement sessions to develop over 3000 business requirements for MITS.
In May of 2006, Ohio received CMS approval for the MITS Implementation-Advanced Planning Document and the Request for Proposals (RFP). The MITS RFP can be found on the State of Ohio’s State Procurement Web site: http://www.procure.ohio.gov/RFP/0A06007.pdf. The purpose of the RFP was to contract with one primary vendor to provide services for the design, development and implementation of MITS. These services include: project management, business transformation, systems analysis and design, development, testing, data conversion, training, implementation, stabilization, certification, transition, operation, maintenance, and enhancement.
Proposals were submitted by Affiliated Computer Systems and Electronic Data Systems (EDS). ODJFS, with the Office of Information Technology completed the MITS vendor evaluation process. Based on the outcome of that process, EDS was selected as the vendor for Ohio’s MITS project. EDS began design work on MITS in the fall of 2007. Design, development and implementation work continues as of 2009. Check the http://jfs.ohio.gov/mits/index.stm regularly for updates related to the MITS schedule.
What is MITA and how does it relate to MITS?
MITA is the information technology framework sponsored by CMS to help standardize and encourage use of best practices for state Medicaid programs. CMS is using MITA to drive change throughout the country in how Medicaid programs are managed. There are several benefits to Ohio adopting the MITA framework:
- Congruence with Federal health vision and standards which are currently optional but will be mandatory in the near future.
- Enhanced federal matching rate for system development and implementation. Future federal funding will be based on how well a state is implementing the MITA architecture (i.e. their MITA Maturity Level.)
- Ability to collaborate and exchange parallel technology, data and information with CMS, other state Medicaid programs, and the broader health care marketplace.
- State of the art design principles based on the best practice experiences of Medicaid programs.
- Systems and information that are more focused on Medicaid consumers and the quality of care they are receiving.
MITA principles will affect how Ohio’s Medicaid administrative functions and organization are configured by coordinating similar business processes. Adopting MITA principles gives ODJFS a clear vision and path toward the desired future state for the Ohio Medicaid program and outlines sequential steps to achieve it.
What are some of the benefits that MITS will offer Ohio Medicaid?
When fully operational, MITS will provide many benefits to ODJFS staff, Medicaid providers, consumers, sister state agencies, and other Medicaid stakeholders. Here are just a few of the benefits.
- Integrate currently standalone software and business processes into a single strategic Medicaid system;
- Provide more timely access to Medicaid data to support policy making, identify areas of progress or areas needing intervention and better informed decision making.
- Offer Web-based access to providers for claims submission as well as claims verification and status reports; submission of prior authorization requests; verification of consumer eligibility status, and submission of provider enrollment applications and re-applications.
- Include clinical claims editing with the ability to track the appropriate utilization of certain health care services.
- Automate several manual and paper driven processes through implementation of an electronic document management system.
What will not change with MITS?
The following will not change with MITS:
- ODJFS will maintain its responsibility to administer the Ohio Medicaid program and related health care programs. As such ODJFS will maintain its commitment to assuring compliance with state and Federal laws and rules, cost efficiency, program integrity, and consumer access to quality care.
- Medicaid covered services will not be changed by MITS.
- Health care providers will still need to have an approved Medicaid provider agreement in order to participate in the program.
- Providers will still submit claims for services provided to Medicaid consumers and receive payment for them. ODJFS will remain the primary point of contact regarding issue resolution for claims.
- Providers will continue to be able to verify consumer eligibility through the new MITS Web Portal.
- Specified Medicaid services will still need to be prior authorized before they can be approved for Medicaid payment.
- Information on the Medicaid program, such as billing rules and coverage, will continue to be available on the ODJFS Website and in the public section of the new MITS Web portal.
- Existing direct deposit information for providers will not change with the implementation of MITS. Providers will be able to have their Electronic Funds Transfer (EFT) go to a personal or business checking or savings account.
- Some functions related to the Ohio Administrative Knowledge System (OAKS) such as EFT, will not change as a result of MITS.
When will ODJFS implement MITS?
Phase 1 of MITS is targeted to "go live" on August 2, 2011. Visit the MITS project Web site for the most up-to-date project information at http://jfs.ohio.gov/mits/index.stm.
What other states that have implemented IT systems like MITS?
Indiana, Oregon, Florida, and Oklahoma are a few of the States where HP has already implemented projects using the same technology contained in MITS.
What is the cost to implement MITS?
The estimated cost of the project is approximately $260 million; and currently the largest IT project in the State. Because the State of Ohio is considered a MITA early adopter state, the MITS project has adopted components of the Federal MITA. Thus, Ohio is receiving a large percentage of federal funding from CMS for the project. For some activities, ODJFS is receiving up to ninety percent federal matching funds from CMS.
What is IV&V?
Independent Verification and Validation or IV&V is a type of project auditing that helps to troubleshoot potential issues and provide solutions before a project is operational. IV&V is commonly used for large projects such as MITS. It is administered by an external and independent body with the technical and business expertise unique to the project. In February 2008, ODJFS selected CSG as the vendor to complete IV&V for Ohio’s MITS project.
What features will be available in the new MITS Web Portal?
The new MITS Web Portal will retain all of the features currently available in the current legacy Medicaid Portal and will introduce many new features. The new MITS Web Portal will contain two sections, one open to the public and one that is secure for access only by providers or their designees.
The public section will be accessible to anyone with Internet access via Internet Explorer version 6.5 8.0 or Firefox 1.5 3.5.. High speed connectivity is strongly recommended. The public section will contain general information about the Ohio Medicaid program including fact sheets, forms, policy manuals, and other program information. New features available via the public section of the new MITS Portal include:
Ability for the public to locate Medicaid providers via a Provider Directory
Ability to view fee schedules
Ability to submit and track Provider Enrollment applications and related documentation
Ability to enroll as a trading partner
Ability to submit Prior Authorization requests for medical services
The secure section of the new MITS Web Portal will continue to be private and security protected as it contains confidential and personal information. It may be accessed only by providers, and other authorized entities, who have a formal business relationship with Ohio Medicaid. These providers can perform all current functions provided by the current legacy Medicaid Portal (direct data entry of claims, Medicaid eligibility verification and obtaining remittance advice) plus other functions such as:
Maintain certain provider demographic information
Submit and track requests for prior authorization for certain services or equipment, including electronic submission of medical documentation and other related attachments
Receive "real time" status report of requests for prior authorization, preventing duplicate submissions
Enroll as a Medicaid provider
Submit claims in "real time," including related attachments
Receive immediate feedback regarding claims that have been submitted for payment and have the opportunity to revise and resubmit claims online
In the months prior to MITS implementation, providers and other key stakeholders will receive information and training regarding how to use the new MITS Web portal available through MITS.
What is interChange?
interChange is the replacement MMIS that will be used as the core for developing the Ohio’s MITS application. It will provide essential business functions and information needed to manage Ohio Medicaid in the future.
interChange is also used by other states, such as Alabama, Wisconsin, Kentucky, and Florida, as the core MMIS required to manage the Medicaid Program. To meet Ohio’s specific business/operational needs, a customized version of the interChange system is under development. To ensure that interChange meets these needs, ODJFS staff is working with the MITS vendor, HP, to examine current business processes and develop Ohio specific technical requirements and processes.
What are some of the subsystems (other than the Medicaid Web Portal within MITS and what functions will they provide?
MITS will offer a number of subsystems that will automate labor intensive and paper oriented processes. Some examples include:
- The Electronic Document Management System will aid in addressing the large volume of paper that is currently managed using paper intensive, manual processes. By using scanner technology, EDMS facilitates more efficient automated processing and storage of these documents.
- Through the Contact Tracking Management System, stakeholders such as legislators, providers, and consumers and their advocates may see quicker resolution of problems that require research. CTMS provides ODJFS Call Center representatives with access to the status of prior contacts regarding a provider or consumer. With the full background being readily apparent, Call Center Representatives will more easily be able to assess the situation and respond to concerns.
What are examples of MITS clinical rules that will be used to review medical procedures?
Clinical rules will dictate the circumstances when a Medicaid claim should be paid, denied or suspended for further review. The MITS claims processing system will contain hundreds of rules reflective of Medicaid policy.
- Restricting certain procedures to only males or females.
- Disallowing payment for cosmetic procedures not covered by Medicaid. Disallowing separate billing for procedures that should have been billed as bundled.
- Prohibiting payment for procedures that may not be paid more than once, such as a hysterectomy or gall bladder removal.
What is a Medicaid Clinical Claims Editor?
The Medicaid clinical editor is an auditing tool that will review medical procedure and diagnostic codes (such as HCPCS, CPT and ICD-9 Diagnosis Codes) using health care industry standard guidelines. The clinical editor will review Medicaid claims At the base level, the editor will determine whether or not to pay the claim and what amount to pay. It will also review claims to prevent inappropriate payment for duplicate, re-bundled, mutually exclusive, incidental and pre/post-operative care. Additional higher level review then occurs to prevent payment for billing errors such as age or gender conflicts, experimental and obsolete services.
What are the Benefits of the MITS Clinical Editor?
The MITS clinical editor will improve claims payment accuracy, apply consistent payment policies in accordance with health care industry standards, increase ODJFS’ ability to modify payment rules as coverage policies change, and reduce the number of claims that have to be manually reviewed.
How will MITS help reduce fraud, waste or abuse in the Ohio Medicaid program?
MITS will contain software and business processes to help identify unusual billing patterns so that in-depth reviews can be performed to document the presence of billing errors or misutilization. Additionally, claims processing in MITS will contain clinically oriented programs that will identify appropriate sets of procedures to prevent payment of claims that are billed inappropriately and ensure that Ohio-specific Medicaid policies are being followed.
How will MITS improve the efficiency of prior authorization requests?
Requests for prior authorization will be submitted through the Medicaid web portal. Necessary clinical or programmatic documentation can be submitted via fax or uploaded on the web portal. MITS will also be able to incorporate information for PAs issued through other approved authorization systems, e.g. Health Care Excel. Automated work flows will expedite the review process and speed up decisions.
In MITS, How will Providers know if their PA request has been approved?
Providers will continue to receive a notification letter of the result of the review. In addition, Providers can check the web portal to find out the status of the request.
What is the PA tracking number?
A PA tracking number is automatically assigned by the MITS system when a request is submitted. Although the PA tracking number is the number that is used to file a claim, the provider must wait until they have the Medicaid issued letter outlining what has and has not been approved before providing services or equipment to Medicaid eligible consumers.
Do all providers have to enroll through MITS?
Providers, including long-term care providers, will enroll through MITS. Enrollments will be completed on the Web Portal and documents required with the application can be uploaded or faxed. Providers should use the web portal to enroll whenever possible. Using the Web Portal will expedite the enrollment process, the provider will obtain a provider number more quickly than it currently takes to obtain a provider number and, therefore, be paid more quickly for services provided to Medicaid consumers.
Once enrolled as a provider, will I have to re-enroll?
Providers will be required by Ohio statute to re-enroll every seven years to remain an active Medicaid provider.
Re-enrollment can be done through the new MITS Web Portal. A reminder letter will be sent prior to the date that re-enrollment is due. This re-enrollment will validate known provider information and allow providers to keep their information up-to-date. Re-enrollment for the majority of providers will occur after MITS implementation.
Why is the Application Tracking Number (ATN) important?
The ATN is the number used to track a provider application. This number is used by providers for checking the status of the application or completing coversheets used for submitting required documents. Using the ATN ensures that the correct application can be located and that any documentation sent by the provider is stored with the correct application.
Will MITS affect those outside ODJFS?
Yes. ODJFS staff are not the only system users who will have to learn to use the new MITS system. Providers, and other stakeholders will also need to be trained on how to use certain features of the MITS system. Beginning in May, 2010, ODJFS will begin conveying information to Medicaid service providers and other affected stakeholders about the features and benefits of MITS. Additionally, HP and OHP are developing a training curriculum and schedule that will be shared with the provider community in the June, 2010 timeframe.
How will MITS change current business practices that providers use with Ohio Medicaid?
MITS will offer providers more information regarding their business dealings with Ohio Medicaid. They will also be able to get this information quicker via the internet-based Medicaid portal. Using the Web portal will allow users more efficient business practices than those used when submitting paper claims.
Will Consumers still be able to select the MCP of their choice?
Yes, the MITS implementation does not change managed care enrollment policies. MITS does provide streamlined functionality to support Ohio Medicaid's managed care policies and procedures.
Can MCPs submit fee for service and encounter data claims?
No, Managed Care Plans (MCPs) can only submit encounter claims. MITS contains functionality to ensure that MCPs only submit encounter claims. Only providers and their designated trading partners can submit fee-for-service claims.
How will reconciliations be handled in MITS?
Managed Care Plans (MCPs) can submit requests for reconciliation and receive the outcome via the new MITS Web Portal. Requests submitted on the Web Portal are automatically routed to the correct ODJFS staff. The outcome of the requests is available on the MITS Web Portal for the MCP to retrieve.
Can claims adjustments be sent on EDI files after MITS is implemented?
Yes. Adjustments can continue to be sent on the 837 and will automatically be processed by MITS unless the claim suspends for manual review.
Can adjustments be submitted on the OHP Web portal?
No. Paper or EDI adjustment requests should be submitted to OHP in the same manner, until the new MITS portal is available.
Can sister agencies adjust claims electronically?
After MITS is implemented, sister agencies can submit adjustments electronically.
Why is the clinical editor a critical component of claims processing?
The new MITS clinical claims editor called ClaimCheck allows ODJFS greater ability to detect fraud and abuse, thereby avoiding costly overpayments. It also will increase ODJFS’ ability to modify payment rules as coverage policies change.
How will ClaimCheck function in MITS?
When fully implemented, MITS will call on the edit/audit subsystem and the ClaimCheck software during claim adjudication. After the MITS edits and audits are applied, the ClaimCheck edits will be applied. MITS will evaluate the results and post the appropriate error status codes (ESC) to the claim. The claim adjudication process will then continue.
Why should a provider verify Medicaid eligibility on a recipient prior to rendering services?
Eligibility needs to be verified, which can be done through the MITS Web Portal, to ensure the recipient qualifies for Medicaid services. Services provided to patients who are not eligible for Medicaid program coverage will not be reimbursed by Medicaid.
What should a provider do if the recipient doesn’t have his/her Medicaid card with them?
Eligibility can be verified without the Medicaid card via the Web Portal using the Medicaid ID number or the Social Security number, the date of birth, and the date of service.
What are some examples of how business processes might change?
The following chart gives some examples of how current business processes might change with the implementation of MITS:
|Current (As-Is) Environment
||MITS (To-Be) Environment
|Medicaid claims processing system is dependent upon a nightly batch adjudication cycle.
||Online adjudication will allow the submitter to know the status of the claim in near real time. Any necessary corrections can be made immediately.
|Attachments must be submitted in hard copy form.
||Attachments may be scanned and downloaded via the MITS Web portal.
|Eligibility, as of the previous day, can be verified using the IVR.
||Eligibility can be verified in real time, using either the Web portal or the IVR.
|Providers complete hard copy paper enrollment forms which are submitting with licensing documentation via mail.
||Providers can enroll and re-enroll online via the Medicaid Web portal. Scanned copies of licensing documents can be uploaded using the computer.
How will ODJFS help providers get ready for the new MITS?
ODJFS and HP staff began meeting with professional associations representing health care providers and other interested stakeholders in April 2010 to offer information about MITS and its features and benefits. A calendar schedule of Association meetings has been created and HP and OHP is attending and conducting presentations as requested. ODJFS and HP are providing regular communication to providers and other stakeholders via the MITS Web site, MITS Newsletter, Provider Information Releases, and through collaborative communication with professional associations.
In September 2010, the ODJFS and HP began offering training for providers, sister state agencies, county and regional agencies, and other identified stakeholders in order to prepare them for the transition to MITS. In addition, ongoing training will continue for newly enrolled Medicaid providers and as a refresher to existing providers. ODJFS will also continue to offer access to technical assistance via the existing Medicaid provider help desk and through a new online MITS Provider Portal user manual which will serve as an ongoing aide to providers about how to submit information to Ohio Medicaid using the functionality available via the new MITS Web Portal.
As a provider, what do I need to do to get ready to use MITS?
Providers should make business decisions about what tools and internal business processes they will need in order to submit HIPAA compliant Medicaid claims to ODJFS. Providers can find more information about HIPAA compliance at the following Internet page: http://jfs.ohio.gov/ohp/infodata/hipaacomcds.stm
In order to use the Medicaid Web portal, providers must have access to a computer, appropriate internet access, and have processes in place to safeguard Protected Health Information (PHI). Medicaid providers lacking high-speed internet access should consider adding it due to the inability of dial up access to accommodate large files that will be transmitted via the Web portal. Providers wishing to submit attachments via the Web portal will also need software to scan and save documents.
More specific information will be communicated to the provider community as MITS implementation gets closer.
How will my needs for support from the ODJFS Call Center change with MITS?
The nature of calls to the Medicaid Provider Call Center may change because of MITS implementation. As the MITS Web Portal expands provider’s use of a web-based door for Ohio Medicaid, an increased number of providers will be able to submit and check on the status of their claims via the internet. Thus, OHP staff currently working in the provider call center will likely perform some different provider service functions after MITS is implemented.
Also, Medicaid Call Center representatives will have access to the status of prior contacts made by a provider or consumer via the new Contact Tracking & Management System (CTMS). With the documented history of previous contacts, Call Center Representatives will be able to quickly assess a situation and respond appropriately to concerns. CTMS will provide ODJFS Call Center representatives with access to the status of prior contacts made regarding a claim, provider, or consumer. With the full background being readily apparent, Call Center Representatives will more easily be able to assess the situation and respond to concerns.
How will all the new systems associated with MITS work with the existing state systems?
MITS will need to link a vast number of components and other ODJFS systems together so they can communicate with each other in an automated manner. To address this need, ODJFS purchased and implemented an Enterprise Service Bus (ESB) to support the secure transfer and communication of electronic data files between MITS, the eligibility systems and more than 160 external entities.
If a provider was unable to attend a provider training, how can the training materials be obtained?
The pre-implementation provider training materials are available at http://jfs.ohio.gov/mits/MITS%20Provider%20Training.stm
Additional questions about MITS?
Periodically check the MITS Web site at http://jfs.ohio.gov/mits/index.stm for updates on FAQs and other information regarding the MITS implementation. Questions may also be submitted to MITS_FAQs@jfs.ohio.gov.