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Fall 2020
Stay in the Know About Coronavirus

Find timely information to support your patients through telemedicine, testing, COVID-19-related coding, and other resources we are sharing to help you during this pandemic.
Additional Medicaid Resources
Additional questions and feedback regarding Medicaid policy can be directed to [email protected]
OhioMHAS-certified providers can contact [email protected] .
Additional COVID-19 information and resources can be found at coronavirus.ohio.gov or by calling 1-833-4-ASK-ODH (1-833-427-5634).
Provider Enrollment    

Effective November 25, 2019 Ohio Department of Medicaid (ODM) implemented a policy under Administrative Code 5160-1-17 requiring all
providers to obtain a National Provider Identifier (NPI) and keep it on file with ODM.
If you are a provider submitting claims to Aetna Better Health of Ohio, you must obtain an NPI and update your records with ODM to include your NPI. Please refer to the notice linked here: https://medicaid.ohio.gov/Portals/0/Providers/Enrollment%20and%20Support/Letter_NPI_req_or_Waiver_providers_Final.pdf for more information on how to obtain an NPI and how to report your individual NPI to ODM.
If you do not currently have an active Medicaid ID and need to enroll as a new provider or you are a current Medicaid provider and need to revalidate please visit: https://portal.ohmits.com/Public/Providers/Enrollment/tabId/44/Default.aspx
Please review and ensure there is an active Medicaid ID and NPI associated with your provider record in MITS: https://portal.ohmits.com/Public/Providers/tabId/43/Default.aspx by December 31, 2020 to prevent claim denials in the future.
For more details on this requirement, please visit http://medicaid.ohio.gov/Provider/EnrollmentandSupport/ProviderEnrollment.
Centralized Credentialing

To improve upon the credentialing process for Medicaid providers, the Ohio Department of Medicaid (ODM) will create a centralized credentialing by assuming responsibility for provider credentialing beginning in the first quarter of 2021. This move to centralized credentialing will eliminate the need for providers to credential with each health plan separately. Due to this change, all providers must be registered in the Medicaid Information Technology System (MITS). Credentialing for Medicare will remain a responsibility of Aetna. Providers can expect more information on this topic in the coming months.
Tips to Avoiding Authorization Denials

The goal of Aetna Better Health of Ohio is to always provide a prompt response to the requests submitted and we need your help!!  Submission of all necessary information helps get our members what they need, while in your care.  Please see the provider portal for the necessary Prior Auth forms.  It is vital that all lines are filled out in their entirety, including CPT codes, diagnosis codes, and your National Provider Identification (NPI).  If not, the case could pend for lack of clinical information.  The primary reason for denials within ABH is lack of clinical information received.  Please ensure that you are prepared with appropriate clinical during your submission.  Please reach out if you are not sure what needs sent or watch for a fax back from us telling you what will help process your case.  Thank you so much and have a wonderful fall and holiday season. 

Best wishes,

ABH Utilization Management
Specialist Feedback and Reports   
Continuity and coordination of care for our members is extremely important to prevent medical errors. However, we have heard from our Primary Care Practitioners (PCP) that they do not always receive feedback and reports from specialists to whom they refer patients. In our most recent Provider Satisfaction Survey, PCPs reported that they only receive feedback/reports in a timely manner 15% of the time. You can help by ensuring that your specialty practice submits those reports back to PCPs as soon as they are received. Please help us ensure member safety by doing your part in following up with your member's PCP.

We would love to hear from you! If you have any ideas that can help ABHO better support you in your efforts to ensure continuity and coordination of care, please call us at 1-855-364-0974.
Did you know that Diabetes Self-Management Education (DSME) is a covered benefit for Aetna Dual Members?

This benefit allows the provider to write an order for the member to attend 1:1 or group Diabetes education sessions. This benefit can be used for newly diagnosed patients and for patients who were diagnosed months or years ago.

Please use the below codes when billing for Diabetes education.

CPT CODE
DESCRIPTION
PRIOR   AUTHORIZATION
98960
Self-Management & Training (1 PT)
Not required
98961
Self-Management & Training (2-4 PT)
Not required
98962
Self-Management & Training (5-8 PT)
Not required
 
G CODE
DESCRIPTION
PRIOR   AUTHORIZATION
G0108
1:1
Not required
G0109
Group
Not required
We are here to help
If you have any questions, please contact Provider Services at 1-855-364-0974.

Changes to out-of-network CBHC Providers

If you are a community behavioral health center (CBHC) that is currently not participating with Aetna Better Health of Ohio (ABHO) and are currently or intending on providing services to our member(s), you will want to begin our contracting process to prevent potential non-payment.   As communicated in MITS BITS Stakeholder Information Release (Release 8/07/2020), after October 1,2020, non-contracted providers may need a prior authorization for all services or may experience claim denials due to contracting status.

If you are interested in learning more about becoming in-network, please contact Provider Services at (855) 364-0974 or email [email protected]

Resource link to MITs BITs: https://bh.medicaid.ohio.gov/Newsletters
Financial Liability for Payment for Services

Balance billing enrollees is prohibited under the MyCare Ohio plan. In no event should a provider bill an enrollee (or a person acting on behalf of an enrollee) for payment of fees that are the legal obligation of Aetna Better Health of Ohio. This includes any coinsurance, deductibles, financial penalties, or any other amount in full or in part. Providers must make certain that they are:
  • Agreeing not to hold enrollees liable for payment of any fees that are the legal obligation of Aetna Better
  • Health of Ohio, and must indemnify the enrollee for payment of any fees that are the legal obligation of Aetna Better Health of Ohio for services furnished by providers that have been authorized by Aetna Better Health of Ohio to service such enrollees, as long as the enrollee follows Aetna Better Health of Ohio's rules for accessing services described in the approved enrollee Evidence of Coverage (EOC) and or their Enrollee Handbook.
  • Agreeing not to bill an enrollee for medically necessary services covered under the plan and to always notify enrollees prior to rendering services.
  • Agreeing to clearly advise an enrollee, prior to furnishing a non-covered service, of the enrollee's responsibility to pay the full cost of the services.
  • Agreeing that when referring an enrollee to another provider for a non-covered service, provider must make certain that the enrollee is aware of his or her obligation to pay in full for such non-covered services
Fee Table

Providers must bill according to CMS and Medicaid guidelines. It is also the provider's responsibility to be familiar with the latest billing practices.   Aetna is not responsible for instructing providers how to correctly bill for services.  
 
Also, providers should frequently check the state's  Fee Schedule & Rates  website as updates are always occurring to the fee schedules for Medicaid.




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