Ohio providers: Are your PNM affiliation steps complete to avoid claims payment issues?

June 2023

We are aware of the delayed claim payments due to claim rejections by the state’s fiscal intermediary and are working directly with them to resolve this as quickly as possible. Please continue seeing members and we will use providers.eyesynergy.com for progress updates.

The Ohio Department of Medicaid (ODM) has identified several affiliation issues that impact billing claims. It is imperative that you fully execute all steps when affiliating a rendering provider to their group to avoid claims payment issues. ODM has indicated that providers tend to leave affiliations in 1 of 2 incomplete statuses (Affiliation Status):

• Pending approval 
• Confirmed

A provider affiliation can be initiated and completed by the group or through the rendering provider. If the affiliation is initiated through the rendering individual, it is not complete and remains in a “Pending Approval” status until the group accepts and saves the affiliation. At that point it will appear as “Confirmed.”

There are 2 remaining critical steps for the provider affiliation to be sent downstream and receive an “Active” status:

• Click <Save> at the top of the page. Once saved, the user will have a new <Submit for Review> button appear.
• Click <Submit for Review>. Users must click on this button to complete the process and submit the affiliations downstream. Affiliations are fully executed ONLY once this final step has been taken.

If these steps are not completed, the provider affiliation is not sent, and providers will experience claims payment issues.

For more information

For affiliation assistance, please explore the PNM Provider Education & Training Resources to access Quick Reference Guides (QRGs), including the QRG: Adding a Group Affiliation to assist you with this process.

Questions?

Reach out to us at 844-756-2724. Thank you for your continued patience.