07/18/2012  Therapy limit audit correction and billing instructions: Certain claims for therapy services have incorrectly paid for services beyond program limits in MITS without a prior authorization number. A limit audit has allowed certain claim lines to pay a reduced number of therapy service units rather than deny all services for that date of service as it was designed to do. This defect has been corrected and limit audit will correctly adjudicate all therapy claims received after July 6, 2012.

06/19/2012  ICF-MR December Payment: We identified a systems issue that prevented accurate claims generation for ICF-MR services for the December services payable in January. In order to ensure sufficient resources for services to individuals residing in ICFs-MR, we calculated an interim payment for each provider using historical payment information.

We are now able to reconcile actual claims for the December services with the interim payment. Payments for ICF-MR services in the week of June 18, 2012 will reflect this reconciliation. As providers review their remittance advices for that payment, things to remember include:

1) Some claims have already been paid for December services, either through the original January claims generation process or through the 9400 process in the subsequent months. However, the claims generation programming generates all of the claims for November services. As a result, there is a high volume of denials for duplicate claims.

2) The amount of the interim payment made in January is being offset against the amount due as a result of actual claims generation. The interim payment was calculated by comparing the December payment made to the November payment and was an estimate of additional funds due to the providers for November services. The reconciliation may result in additional funds due to the provider or funds due to department.

3) Funds due to the provider will be reflected in the payment on June 21, 2012.

4) Differences between the interim payment may be due to a number of factors including claims for December services processed since the interim payment was made. Funds due to the department will be recovered through a reduction in the July payment for June services.

Every effort has been made to ensure the accuracy of the reconciliation process. Thank you for your patience as we have worked to resolve these system issues.

06/7/2012: Waiver Eligibility: All known issues related to new waiver eligibility have been corrected. ODJFS is still in the process of correcting some historical waiver eligibility issues.  If you have questions, please contact the provider call center.

5/23/2012: Waiver Eligibility: An update to MITS will be released on May 24th, 2012 which will address recipients with new waiver eligibility. The issues with past waiver eligibility are still being researched. In the interim, please continue contacting the provider call center to report waiver eligibility issues.

5/11/2012: December ICF-MR Payment:  As you know, when we generated the ICF-MR payment in December 2011 for services provided in November 2011, we identified a systems issue that caused only a portion of the claims to generate.  Subsequently, in order to ensure sufficient resources for services to individuals residing in ICFs-MR, we calculated an interim payment for each provider using historical payment information. 
 
We are now able to reconcile actual claims for the November services with the interim payment.  Payments for ICF-MR services in the week of May 14, 2012 will reflect this reconciliation.  As providers review their remittance advices for that payment, things to remember include:
 
1)  Some claims have already been paid for November services, either through the original December claims generation process or through the 9400 process in the subsequent months.  However, the claims generation programming generates all of the claims for November services.  As a result, there is a high volume of denials for duplicate claims.
 
2) The amount of the interim payment made in December is being offset against the amount due as a result of actual claims generation. The interim payment was calculated by comparing the December payment made to the November payment and was an estimate of additional funds due to the providers for November services.  The reconciliation may result in additional funds due to the provider or funds due to department.
 
3)  Funds due to the provider will be reflected in the payment on May 17, 2012. 
 
4)  Differences between the interim payment may be due to a number of factors including claims for November services processed since the interim payment was made.  Funds due to the department will be recovered through a reduction in the June payment for May services. 
 
Every effort has been made to ensure the accuracy of the reconciliation process.  The reconciliation for the interim payment made in January 2012 for December services is tentatively scheduled for next month.  Thank you for your patience as we have worked to resolve these system issues.

Hospice Claims - Place of Service (POS)
MITS was incorrectly denying payment for respite care (T2044) and general inpatient care (T2045) for nursing facility place of service (POS) codes 31 and 32.  The claims payment logic was corrected.  Providers with denied claims may now resubmit them.

Hospice Claims - Place of Service (POS)
In the old Medicaid reimbursement system, hospice claims for respite care (T2044) and general inpatient care (T2045) were correctly paying for these place of service (POS) codes: inpatient hospital (POS 21) , hospice facility (POS 34), and nursing facility (POS 31 & 32). It was recently discovered that MITS was excluding payment for these services delivered in nursing facilities.  This exclusion was removed.  Providers with denied claims may now resubmit them.   

12/16/2011: As part of the ongoing effort to resolve eligibility issues, updates to the Medicaid Information Technology System (MITS) are planned for Monday, December 19, 2011. These updates will address issues some providers are having with waiver and dual-eligible denials. There are two parts to this update: 1) a repair to correctly assign waiver type and waiver spans into MITS, and 2) a repair to continue the appropriate dual-eligible waiver spans in MITS.

11/2/2011:  Hospice Claims - Place of Service (POS): MITS was incorrectly denying payment for respite care (T2044) and general inpatient care (T2045) for nursing facility place of service (POS) codes 31 and 32.  The claims payment logic was corrected.  Providers with denied claims may now resubmit them.

11/2/2011: Hospice Claims - Place of Service (POS):In the old Medicaid reimbursement system, hospice claims for respite care (T2044) and general inpatient care (T2045) were correctly paying for these place of service (POS) codes: inpatient hospital (POS 21) , hospice facility (POS 34), and nursing facility (POS 31 & 32). It was recently discovered that MITS was excluding payment for these services delivered in nursing facilities. This exclusion was removed. Providers with denied claims may now resubmit them.  

10/31/2011: There are known issues with the eligibility of various waiver recipients. ODJFS is working diligently to resolve these issues with an estimated completion date of November 9, 2011.

10/19/2011:  Reporting Healthchek (EPSDT) Services in an 837P Transaction

9/23/2011:  Updates to Hospice Claims

9/12/2011:  On September 9, 2011, HP reported a production outage. MITS was down from 4:39 pm to 5:23 pm.

9/12/2011:  COB: Bypassing the TPP

9/12/2011:  COB: Claim-Level Information, Detail-Level Information and Adjustments

9/6/2011: Special Payment to Hospice Providers

8/26/2011:  Diagnosis Codes for State Plan Home Health, PDN, ODJFS Administered Waivers and Payment for Multiple Visits

8/26/2011: Diagnosis Code

8/26/2011: Carrier Codes & Payer Identification

8/24/2011: Interim Bills, Prior Authorization & Pre-certification

8/23/2011: Tips for MITS Access, TPL, Diagnosis Codes & Suspended Hospice Claims

8/19/2011: The new Medicaid Information Technology System (MITS) went live on August 2, 2011. Since then, MITS has processed almost 3.8 million claims and disbursed more than $438 million to providers. As with any new system, however, especially a system this large and complex, technical issues inevitably arise.

While the system continues to process claims, some claims that providers submitted are suspending or denying due to a system problem. This is causing some consumers who are eligible to appear to be ineligible. Hewlett Packard (HP), the vendor contracted to implement MITS, is working to correct this issue. Although it is affecting a relatively small number of Ohio’s 90,000 Medicaid providers, we deeply regret any inconvenience or hardship it may have caused.

In order to ensure that the affected providers receive the compensation they are owed, we will be processing estimated claim payments for those providers today, for receipt on Thursday, August 25. We will adjust future payments as needed to account for any over or underpayment.

As soon as a solution is implemented, providers will be notified of any actions they should take.

For up-to-date information about MITS, go to http://jfs.ohio.gov/mits/index.stm.

8/19/2011: Attention Pharmacy Providers
Thank you for your patience as we transition to a new claims payment system. This week's payment includes drug claims adjudicated by pharmacies to a paid status on July 16 through July 26. Claims processed to a paid status on July 27 through August 5 should appear on your payment next week. We still are having difficulty processing reversed and adjusted claims. As a result, these will be processed on a future date. In the meantime, payments will be made for original claims only: claims that have not been adjusted or reversed after the original payment. This may cause your payments to be slightly higher for a few weeks. As we work to resolve this issue, we will continue to provide updates. In addition, we have received a few compound claims with ingredients not recognized by the system (for example, an NDC was entered using the UPC for distilled water). As a result, these will not appear on your payment. We are working to resolve this issue, as well.

8/19/2011:  Tips for Place-of-Service (POS) code

8/16/2011:  Tips for Code Sets, Procedure Code Modifiers, Coordination of Benefits and Group Affiliation

8/15/2011:  Tips for Wraparound Claims for FQHCs and RHCs

8/12/2011:  Tips for Common Claim Denials for Hospital and Dental Providers

8/9/2011:  Attention Ohio Medicaid Pharmacy Providers
We recently encountered a problem with pharmacy claims payment.  As a result, pharmacy claims will not be paid with the remittance advice dated August 10, 2011. Instead, claims adjudicated by pharmacies to a paid status anytime between July 16 and July 29 are expected to be paid with the remittance advice dated August 17.
In addition, on August 3 we learned that some of the drug coverage files were corrupted, which resulted in some drug claims denying incorrectly. We have made an adjustment to the drug files, and claims should now process normally. If your pharmacy submitted claims that did not process on August 3 or 4, please resubmit the claims to ACS for processing, using the original date of service.

8/1/11:  MITS Implementation Known Issues

8/1/11:  The MITS Web Portal goes live at 6:00 AM on Tuesday, August 2, 2011.

7/29/11:  The Interactive Voice Response System (IVR) will be unavailable on Monday, 8/1/11, from 10:00 PM to until Tuesday, 8/2/11 at 12:05 AM for the conversion from the existing Medicaid Management Information System to the new MITS  System. 

7/25/11:  As of 5:00 p.m. EDT on July 25, 2011, Early MITS Portal Registration is closed.  Registration will be available again once MITS goes live on August 2, 2011, at 6:00 a.m. EST. Also, you will not be able to access your MITS account until MITS goes live on August 2, 2011. Continue to check  http://jfs.ohio.gov/mits/index.stm for MITS updates.

7/22/11: The MITS Web Portal will be down for maintenance from 11:00 p.m. Sunday, July 24, 2011 through 11:00 a.m. Monday, July 25, 2011.

7/19/11:  The MITS Web Portal will be down for maintenance from 6:00 p.m. Tuesday, July 19, 2011 through 6:00 a.m. Wednesday, July 20, 2011.

7/7/11:  The MITS Web Portal will be down for maintenance from 6:00 p.m. Thursday, July 7, 2011 through 7:00 a.m. Friday, July 8, 2011.

7/1/11:  The MITS Web Portal will be down for maintenance from 6:00 p.m. Saturday, July 2, 2011 through 6:00 a.m. Sunday, July 3, 2011.

6/22/11: The MITS Web Portal will be down for maintenance from 9:30 p.m. Friday, June 24, 2011 through 12:30 p.m. Saturday, June 25, 2011.

 For more information about MITS please go to:  http://jfs.ohio.gov/mits/index.stm