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Ohio providers: Avoid claims payment issues and update your information in PNM and complete affiliation steps

December 2023

We’re now required to use the Ohio Department of Medicaid (ODM) Provider Network Management (PNM) system as the official “source of truth” for all Medicaid provider data.

It’s important you make sure the ODM’s PNM system is updated to reflect your current information. This includes:

  • Provider affiliations
  • Service location adds and terms
  • All other demographic changes

You must continue to update data in the PNM system as changes occur. If your provider data in the PNM system doesn’t match the provider data submitted on a claim, we’ll deny your claim.

Avoid claim billing issues

ODM has also identified several affiliation issues that impact billing claims. Make sure you fully execute all steps when affiliating a rendering provider to their group to avoid claims payment issues. ODM has found 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 it can be initiated through the rendering provider. If the affiliation is initiated through the rendering individual, it’s 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.”

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

  • Click <Save> at the top of the page, which saves all the updates. 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.

Important: If these steps are not completed, this means the provider affiliation is not sent downstream and you’ll experience claims payment issues. 

Resources

For assistance, please visit the PNM Provider Education & Training Resources page, where you’ll find quick reference guides (QRG), including the QRG: Adding a Group Affiliation to walk you through the process.

Questions?

Please contact us directly at 844-756-2724 if you have any additional questions.