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Ohio Medicaid Extends Timely Filing Deadline Until 2025

Client Alert
December 11, 2024

The Ohio Department of Medicaid (ODM) recently announced that it is extending its timely filing deadline to February 28, 2025. According to ODM, roughly 2% of providers have contract issues preventing them from meeting the previous timely filing deadline of December 1, 2024.

Before March 1, 2025, providers need to:

  • Submit as many claims as they can now to avoid additional manual work and time required to process them after the deadline. If a data fix or system configuration is required to properly adjudicate the claim, ODM will adjust claims successfully received by the system even if the timely filing deadline has passed.
  • Review Provider Network Management (PNM) data associated with claims denied for a contract or affiliation related issue to make sure it is correct. If the PNM data is correct, but a provider received a denial indicating a contract or an affiliation issue, report these issues to ODM’s Integrated Helpdesk (IHD).

Note that even though ODM extended the timely filing requirements, claims submitted after the standard 365-day limit are still subject to post-payment review. ODM may look at evidence of system submissions issues when deciding whether to reverse payment. Evidence may include review of past IHD call logs to verify that providers attempted to troubleshoot their issue.

Providers are encouraged to reach out to the ODM IHD with questions.

If you have questions about the extended deadline and what that means for your organization, please contact Member Daphne Kackloudis at dlkackloudis@bmdllc.com or Attorney Jordan Burdick at jaburdick@bmdllc.com.

Health LawHealthcareOhio Department of Medicaid
Client Alert

Ohio Board of Pharmacy Update: Key Regulatory Changes and Proposals You Need to Know

June 26, 2024The Ohio Board of Pharmacy (BOP) has rescinded certain OAC rules (OAC 4729:5-18-01 through 4729:5-18-06), removing regulations on office-based opioid treatment (OBOT) clinics. The rescissions took effect on June 3, 2024. The BOP also published a new rule, OAC 4729:8-5-01, which sets explicit reporting guidelines for licensed dispensaries and became effective on June 7, 2024.Client Alert

LGBTQIA+ Patients and Discrimination in Healthcare

June 6, 2024In early April, the Kaiser Family Foundation released a study outlining the challenges that LGBT adults face in the United States related to healthcare. According to the study, LGBT patients are “twice as likely as non-LGBT adults to report negative experiences while receiving health care in the last three years, including being treated unfairly or with disrespect (33% v. 15%) or having at least one of several other negative experiences with a provider (61% v. 31%), including a provider assuming something about them without asking, suggesting they were personally to blame for a health problem, ignoring a direct request or question, or refusing to prescribe needed pain medication.”Client Alert

Ohio Recovery Housing Overhaul: New Standards and Certification Requirements Reshape Sober Living Spaces

May 30, 2024Client Alert

Ensuring Fair Access: SB 269 Protects Affordable Medication for Low-Income Patients

May 29, 2024SB 269, introduced on December 19, 2023, will ensure that 340B covered entities, including Federally Qualified Health Centers, Ryan White Clinics, disproportionate share hospitals, and Title X clinics, can acquire 340B drugs without facing undue restrictions or discriminatory practices from drug manufacturers and distributors. This protection is crucial for 340B covered entities to continue to provide affordable medications and comprehensive services to low-income patients.Client Alert

Unveiling Ohio's Pharmacy Board Updates for Distributors, Mobile Clinics, and Controlled Substances

May 24, 2024The Ohio Board of Pharmacy will hold a public hearing on May 28, 2024, to discuss several proposed changes and additions to Ohio Administrative Code (OAC). These changes pertain to terminal distributors of dangerous drugs (TDDDs), mobile clinics or medication units, and the classification of controlled substances.
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