Ohio MITS for Providers

The Ohio MITS (Medicaid Information Technology System) is a replacement for the older MMIS system. The purpose behind upgrading to the new system was to save money – in both labor and materials (paper), and to have a more responsive system that would be able to integrate policy changes more quickly.

For providers, there is much about interacting with Medicaid that does not change. Providers still need to meet the criteria to be an approved Medicaid provider, verify patient eligibility for benefits, and submit medicaid claims for processing to generate payment.

The primary change involving MITS is in the way providers interact with Ohio Medicaid. Besides electronic provider enrollment in Ohio Medicaid, the submission and processing of claims are now purely electronic also, as one of the motivations behind the change was cutting costs involved with a paper-based system. Providers and/or their staff and business associates will be interacting with the system by electronic means.

There are two sections to MITS – one for the public, and a secured section for providers, their authorized staff, or authorized business entities (billing services, etc.) that have a formal relationship with Ohio Medicaid. Coleman Data Solutions is an example of the latter – a state of Ohio EDI trading partner that can accept provider paper claims and submit them to MITS for processing.

Providers can do the same things in MITS that were done with MMIS. They include the following:

  • Enroll as a Medicaid provider
  • Requests for prior authorization
  • Submit claims  – but not paper, only electronic
  • View status of the various functions, with the ability to respond to feedback from the MITS system

The MITS system has subsystems contained within it, including an automated audit function with a slew of clinical rules that impact whether a claim is denied, paid, or suspended while awaiting further action. Some examples of what the clinical rule auditor looks for are procedures not covered by Medicaid, checking for duplicates, obsolete services and/or experimental services, and confirming proper diagnostic codes. Part of the goal of this function is to reduce the number of claims set aside for manual review.

Ohio Medicaid Provider Enrollment with MITS

There are three distinct enrollment related processes for providers.

  • New Ohio Medicaid provider enrollment
  • Revalidation of a an existing Medicaid provider number
  • ORP provider enrollment – Medicaid enrollment as a provider that solely orders, refers, or prescribes

For new provider enrollments, a web application must be completed online. The required documentation (which will be faxed or uploaded to MITS), is dependent on the type of provider you are – individual practitioner, hospital, organization, nursing facility, and so on. Each of these major types are then broken down further.

Revalidation of an existing approved provider enrollment is the result of federal regulations involving the Affordable Care Act. What this means for existing Medicaid providers in Ohio is that they must be renew their authorization every five years, otherwise, they will be dropped from the system and no longer allowed to participate. Providers will receive notification by letter and sent instructions for revalidation – up to 90 days before the renewal deadline. They will use the Ohio Medicaid Provider Portal to go through the renewal process. If providers need further help, they may call the enrollment number at 800.922.3042.

ORP provider enrollment – Ohio medicaid claims must now list the national provider number of the person that ordered, referred, or prescribed items and services. If this information is missing from the claim, the Medicaid provider will not receive reimbursement. There is a new enrollment application starting January of 2014, for those in this ORP provider category to enroll.

Ohio Medicaid provider enrollment can be found on the web here.

System and Other Requirements for Using MITS

  • A computer
  • High speed internet access  – providers will need the ability to transfer large files to the portal
  • Processes in place that secures PHI (protected health information –  HIPAA)
  • Possibly scanning equipment – for imaging paper attachments so they can be sent to the portal electronically
  • Training for whomever will be interacting with the MITS portal

Medicaid Claims Submission with MITS

Ohio MITS dictates how medicaid claims are gathered and processed. No longer can paper claims be submitted to ODJFS. All claims must be submitted electronically through MITS or EDI (electronic data interchange). The EDI system allows for continued paper claims submission, but only by way of an Ohio Medicaid approved EDI trading partner – who then handle the conversion to electronic format.