ODM Extends Timely Filing to 12/1/2024

The Ohio Department of Medicaid (ODM) has further extended the timely filing deadline until December 1st, 2024.

Below is the communication from ODM. The information related to use of the delay reason codes is specific to FFS claims. The MCEs have varied requirements for submission of claims beyond timely filing and providers should contact their MCE representatives for MCE specific information. Additionally, please note that ODM is requesting providers submit claims and not hold them due to ongoing enrollment issues or open tickets. Claims submitted prior to 12/1, even if denied will be able to be reprocessed per the communication below.

Timely Filing Rule Extended to December 1

The Ohio Department of Medicaid (ODM), with the understanding that providers have experienced issues with the Provider Network Management module, is extending the exception to timely filing requirements by two months. We will consider claims that are older than 365 days with a date of service or inpatient discharge date of January 25, 2022, or after, timely if submitted before December 1, 2024. We will deny any claims older than 365 days submitted after this date.

ODM has resolved most claim submission concerns, resulting in a rejection rate of less than 1% for fee-for-service (FFS) and managed care claims. However, there are still some small pockets of rejection impacting providers. We expect to resolve the remaining claim rejections with the October system update. In order to give providers time to submit any currently held claims, and for those remaining system fixes to be in place, ODM is extending the timely filing requirements, outlined in the Ohio Administrative Code rule 5160-1-19 to begin December 1.

Providers should use the next two months to submit all currently held claims. We understand that some providers are holding claims because they have open tickets with the Integrated Helpdesk (IHD), which we do not recommend. As long as providers submit claims prior to December 1, even if they are denied, ODM can reprocess the claims and have them pay correctly according to Ohio Administrative Code rule 5160-1-19. We require claims with greater than 365 days from the date of service, that are submitted on or after December 1, to be submitted manually through the Medical Claim Review Request (i.e. form 6653). Submitting the claims before December 1 will avoid this additional work.

Claims that are greater than 365 days from the date of service submitted before December 1 must include the appropriate Delay Reason Code in the CLM 20 field. You should select the CLM 20 Delay Reason using the following guidance:

• A – Delay Reason Code = 7 (Third Party Processing Delay). Use this code if the claims could not be submitted through the system at all.
• B – Delay Reason Code = 9 (Original Claim Rejected). Use this code if the original claim was submitted, but it could not be processed through the OMES system at that time.

Although ODM extended the timely filing requirements, claims submitted after the standard 365-day limit are still subject to post payment review. ODM may verify evidence of system submission issues, such as reviewing past IHD call logs to verify that providers attempted to troubleshoot their issue. If issues are not evident, the claim payment may be reversed.

For any claims other than those that are older than 365 days with a date of service or inpatient discharge date of January 25, 2022, or after, the timely filing requirements and exceptions in Ohio Administrative Code rule 5160-1-19 still apply. If you wish to dispute a claim payment or denial, for fee-for-service claims you should submit the Medical Claim Review Request (i.e. form 6653) and for managed care claims follow the appropriate managed care organization's appeal process.

For additional help:

For claim assistance, contact the Ohio Medicaid IHD, option 1, or email [email protected]. Representatives are available Monday-Friday, 8 a.m.-4:30 p.m. Eastern time.