Trading Partner readiness for Electronic Data Interchange claims beginning February 1
On February 1, the new Electronic Data Interchange (EDI) vendor will go-live with responsibility for all EDI HIPAA X12 transactions. This does not include claims submitted through the individual managed care portals or claims submitted to MITS via the Provider Network Management (PNM) module. This includes nursing facilities, ICF-IIDs, and medical services billed by pharmacies that bill through a Trading Partner (TP).
THIS INFORMATION IS INTENDED TO HELP PROVIDERS CHECK THE PROGRESS OF THE TPs THEY WORK WITH FOR THE FEBRUARY 1 OHIO MEDICAID ENTERPRISE SYSTEM (OMES) AND NEXT GENERATION IMPLEMENTATION.
This information can change daily as TPs work through their preparations. Updates to the spreadsheet will be posted on this page by the end of the day Tuesday and Friday.
Using available information, TPs have been grouped into categories based on their activity and engagement with claims testing, including fee-for-service and managed care claims. It is important that all TPs have completed system configuration and testing by February 1 to ensure provider claims are processed properly with the cutover to the new claims system. Greater TP engagement and testing reduces the risk of delays in claims submission and payment for providers. Based on the level of engagement of TPs, they are grouped into the following categories, using the “shorthand” titles:
- Active: TPs are part of the Ohio Medicaid pilot TP group or have connected and are testing in CERT environment.
- Onboarded: TPs have responded but have not tested in the CERT environment.
- Tepid: TPs have responded but need to complete setup and test.
- AWOL: TPs have not responded to outreach. Please note TPs who notified Ohio Medicaid that they are no longer active have been removed from these lists.
The spreadsheet can be downloaded and sorted. Trading partners are identified by name and ID number.
NOTE: If your TP is not listed as active, please reach out to them directly regarding their readiness. Testing is not required but highly encouraged. For other questions you can email OMESEDIsupport@medicaid.ohio.gov.
As of July 1, 2021 the Ohio Department of Medicaid (ODM) will suspend new Trading Partner enrollment activity.
This suspension is expected to last through the end of the calendar year, or until the new Ohio Medicaid Enterprise System (OMES) is operational, whichever is later. For more information related to OMES changes impacting the Trading Partner community click on the Ohio Medicaid Enterprise System tile below.
The OMES must be in a production status before new Trading Partner enrollments are resumed. This is to avoid disrupting our provider communities billing and payment of claims.
Thank you for your patience during this delay.
This information is intended to assist organizations who facilitate electronic Medicaid claims reimbursement on behalf of Ohio Medicaid providers.
NOTICE: The standing maintenance schedule for EDI transaction processing is every Sunday from 1-5 a.m. ET / EST. On the second Sunday of each month the maintenance window is expanded from midnight to 7 a.m. ET / EST when needed.
OXI also has a standing maintenance window on Tuesday evenings from 7-11 p.m. ET / EST that could prevent submission of EDI transactions.
ODM will notify all trading partner contacts by email if unplanned or emergency maintenance occurs.
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