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Jul 18
Impact to DODD Provider Billing for Waiver Services in Prior Years

In the Ohio Benefits system, in scenarios where a waiver service is renewed for a new year, the Begin Date for the prior year’s coverage span is being updated with the new year’s Begin Date. This is causing billing errors when a provider attempts to bill for services utilized during the prior year. The coverage span in Ohio Benefits and the claims system (MITS) now reflects the Begin Date for the new coverage year and does not recognize the individual’s coverage for the prior year.  

FOR AWARENESS:
The Ohio Benefits system is currently designed to assume that the original Begin Date for an individual’s waiver would not change when coverage is renewed and instead, the system expects that the End Date will be extended by another year.

In order to resolve this business problem, a system enhancement has been planned for Ohio Benefits that will be implemented in October 2017. With this enhancement in place, Ohio Benefits will retain the original Begin Date, and not replace it. Ohio Benefits will replace the end date with the renewed end date from DODD. MITS will then be updated to reflect the new end date to allow continued waiver eligibility.  

ACTION REQUIRED:
In the meantime, providers should do the following to address billing errors that may occur:

  • If a DODD provider receives any of these codes, wait until the next week and bill again.
    [308, 473, 476, 244, 278]

  • If the error is received again, email Jessica McGonigle at jessica.mcgonigle@dodd.ohio.gov with the subject line “Eligibility Issue” and attach billing rejection or screen shot the rejection screen into email. A dedicated person within DODD has been designated to resolve these issues when the emails are received.


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