The Ohio Department of Medicaid (ODM) has released clarification of ODMs determination that additional validation of Provider Master File (PMF) data with the plans is needed to facilitate better claims processing. To ensure the prompt payment of future claims submitted for services rendered, the managed care entities (MCE) will continue to integrate and use PNM system generated data (PMF and all supplemental files generated by ODM systems).

 

You can read the documents here:

• Continued Validation of Provider Network Management system generated Provider Master File claims data before denial for provider data misalignment
• Managed Care Entity (MCE) Provider Network Management (PNM) System Data Integration Guidance