Why ePRAF is Important – Ensuring Prompt Care
Every pregnant woman with Medicaid coverage should be linked to needed services on her very first prenatal visit. Submission of the ePRAF in the first trimester impacts and improves health outcomes of both mom and baby. An ePRAF submission ensures:

• Medicaid coverage for mom and baby without disruption through the immediate post-partum period of 12 months post-delivery. This is increasingly important given the current redetermination process.
• Serves as pregnancy notification to Managed Care Entities (MCEs) and initiation of timely health care and connection to added resources, and care coordination.

Incentive Program Details
To assist Providers with the prioritization of ePRAF submissions, the Quality Enhancer Incentive Program provides increased payments to eligible Providers who submit the ePRAF via the NurtureOhio website on behalf of their pregnant patients.

• The program incentive is an additional $110 payment on top of the Ohio Department of Medicaid (ODM) Fee Schedule amount for ePRAF submission; bringing the total for a first time ePRAF submission to $200.
• Incentive dollars will only be issued for the first ePRAF submitted for each pregnant Ohio Medicaid patient. Additional ePRAF submissions due to change in pregnancy related risk or needs, will be paid at the allowable ODM Fee Schedule amount of $90.
• To ensure sustainability of this program; all MCEs will be extending this incentive to engaged Providers in 2024. Providers wishing to improve ePRAF submission outcomes should contact their Provider Representative at any of the MCEs for more information.
  • Engaged is defined as those Providers who agree to be included in the program and work with the MCEs on process improvement regarding their submission of ePRAFs.

Payment for Completing the ePRAF
After completing the ePRAF, submit a claim based on the guidelines below:

Code + modifier	Description	Fee Schedule Amount & Incentive Amount
H1000 + 33	Electronic PRAF Submission	$90.00 + $110.00 = $200.00

• No additional coding is needed for the Quality Enhancer incentive to be paid.
• Providers who are engaged in the program will have incentive dollars as described above; paid as a lump sum distribution after 12/31/2024 (allowing for a 90-day data tabulation period).
• FQHC/RHC Billing Guidance – ePRAF submission claims should be reported separately as covered non-PPS services under the “clinic” provider number (provider type 50) of the FQHC/RHC. Billing is Fee for Service and is additional to any PPS visit payment.

Submitting the PRAF 2.0 using NurtureOhio is Easy!

1. Users will need to establish an OH|ID account to access the Provider Network Management System (PNM)
2. With PNM access, next step will be to register within the NurtureOhio site http://www.nurtureohio.com
3. Instructions for completion and submission of the ePRAF can be found at: http://medicaid.ohio.gov/Provider/PRAF
4. If you need assistance, please email the Ohio Department of Medicaid at MomsandBabies@Medicaid.ohio.gov 

 

 

 

 

To ensure sustainability of this intervention package; all MCEs will be extending these offerings to engaged Providers in 2024. Providers wishing to improve ePRAF submission outcomes should contact their Provider Representative at any of the MCEs for more information.

• Engaged is defined as those Providers who agree to be included in the program and work with the MCEs on process improvement regarding their submission of ePRAFs.

PRAF GAP Reporting
Report of attributed, pregnant patients who do not have a submitted PRAF from each Managed Care Entity. Gap reports of pregnant patients can effectively support obstetrical Providers in increasing ePRAF submissions. The MCEs can help monitor Provider “back logs” as well as ensure Providers have a stable process in place to sustain future timely submissions.

 

Billing Review
Financial opportunity review with Provider based on claims data.Review and reporting assists Providers identify process improvement and stabilization regarding billing practices. Correct coding and timely submission on ePRAF claims equate to increased revenue generation for Providers.

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