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Have questions?
You can check your provider manual (PDF). Or call Provider Relations at 1-833-711-0773 (TTY: 711).
You can check your provider manual (PDF). Or call Provider Relations at 1-833-711-0773 (TTY: 711).
Fee schedules and billing codes
You can find the billing codes you need for specific services in the Ohio Department of Medicaid fee schedules.
Getting started
You must file claims within 365 days from the date of service. For inpatient claims, the date of service refers to the member’s discharge date.
Claims for members whose Medicaid eligibility is retroactively back-dated can be filed through the normal claims process.
Online
Availity is our provider portal, which provides functionality for the management of patients, claims, authorizations and referrals. To submit claims online via Availity, choose the button labeled “Medicaid Claim Submission – Office Ally.” This link will take you directly to the Office Ally website where you can submit claims using their online claim entry feature or by uploading a claim file.
Providers must have an Office Ally account to submit claims online. Submission of your OhioRISE claims using Office Ally is free of charge. The status of claims submitted online should be managed through your Office Ally Account.
You can resubmit a claim through Availity or by mail. If you resubmit by mail, you’ll need to include these documents:
An updated copy of the claim — all lines must be rebilled
A copy of the original claim (reprint or copy is acceptable)
A copy of the remittance advice on which we denied or incorrectly paid the claim
A brief note describing the requested correction
Any other required documents
To learn more about claim appeals, just visit our appeals and complaints page.
A claim reconsideration is a request that we previously received and processed as a clean claim.
You can learn about the payment conditions in your provider manual (PDF). Claims payments are adjudicated in accordance with your Provider Agreement. The Centers for Medicare & Medicaid Services (CMS) prohibits plans from applying the mandated Medicaid member appeal process to providers.
If you have questions about how your claim was paid, you can check on our Provider Portal or by contacting the Claims Inquiry Claims Research (CICR) Department at 1-833-711-0773 (TTY: 711). If there's an error, we’ll work with you to resolve the issue. In some situations, we may require you to resubmit the claim for reprocessing.
Need to learn more about claims disputes? You can visit our appeals and complaints page.
Submit an invoice for reimbursement by Aetna for a CANS assessment when this service is not billable via a claim. The invoice needs to contain rendering provider info such as NPI to determine the proper level of reimbursement.
The EFT application for Electronic Funds Transfer needs to be submitted with any initial invoice. If an EFT application was previously submitted by the assessor (if they bill independently) or the assessor’s agency (if they bill through an agency), a new EFT application does not need to submitted again with the initial invoice.
CANS assessments must be submitted to the CANS IT System to be eligible for reimbursement. Email us with all invoices and questions.
EFT/ERA Registration Services (EERS)
EERS offers our providers a more streamlined way to access payment services. It gives you a standardized method of electronic payment and remittance while also expediting the payee enrollment and verification process.
EFT makes it possible for us to deposit electronic payments directly into your bank account. Some benefits of setting up an EFT include:
- Improved payment consistency
- Fast, accurate and secure transactions
ERA is an electronic file that contains claim payment and remittance info sent to your office. The benefits of an ERA include:
- Reduced manual posting of claim payment info, which saves you time and money, while improving efficiency
- No need for paper Explanation of Benefits (EOB) statements
EERS offers payees multiple ways to set up EFT and ERA in order to receive transactions from multiple payers. If a provider’s tax identification number (TIN) is active in multiple states, a single registration will auto-enroll the payee for multiple payers. You can also complete registration using a national provider identifier (NPI) for payment across multiple accounts.
ECHO Health processes and distributes claims payments to providers. To enroll in EERS, visit the Aetna Better Health ECHO portal. You can manage electronic funds transfer (EFT) and electronic remittance advice (ERA) enrollments with multiple payers on a single platform.
Sign up for EFT
To sign up for EFT, you’ll need to provide an ECHO payment draft number and payment amount for security reasons as part of the enrollment authentication. Find the ECHO draft number on all provider Explanation of Provider Payments (EPP), typically above your first claim on the EPP. Haven’t received a payment from ECHO before? You’ll receive a paper check with a draft number you can use to register after receiving your first payment.
Update your payment or ERA distribution preferences
You can update your preferences on the dedicated Aetna Better Health ECHO portal.
Use our portal to avoid fees
Fees apply when you choose to enroll in ECHO’s ACH all payer program. Be sure to use the Aetna Better Health ECHO portal for no-fee processing. You can confirm you’re on our portal when you see “Aetna Better Health” at the top left of the page.
Be aware — you may see a 48-hour delay between the time you receive a payment, and an ERA is available.
We follow the same standards as Medicare’s Correct Coding Initiative (CCI) policy and perform CCI edits and audits on claims for the same provider, same recipient and same date of service. For more information, visit the Centers for Medicare & Medicaid Services (CMS) website.
ClaimsXten®
We use ClaimsXten as our comprehensive code auditing solution that will help payers with proper reimbursement. Correct Coding Initiative guidelines will be followed in accordance with CMS and pertinent coding information received from other medical organizations or societies.
Clear Claim Connection
Clear Claim Connection is a web‐based, stand‐alone code auditing reference tool designed to mirror our comprehensive code auditing solution through ClaimsXten. It enables us to share with our providers the claim auditing rules and clinical rationale inherent in ClaimsXten. You'll have access to Clear Claim Connection through our website and a secure login. You can use Clear Claim Connection coding combinations to review claim outcomes after a claim has been processed. You may also review Coding combinations before submitting a claim so that you can see claim auditing rules and clinical rationale before claim submission.
Correct coding
Correct coding means billing for a group of procedures with the appropriate comprehensive code. All services that are integral to a procedure are considered bundled into that procedure as components of the comprehensive code when those services:
- Represent the standard of care for the overall procedure
- Are necessary to accomplish the comprehensive procedure
- Do not represent a separately identifiable procedure unrelated to the comprehensive procedure
Incorrect coding
Examples of incorrect coding include:
- Unbundling: fragmenting one service into components and coding each as if it were a separate service
- Billing separate codes for related services when one code includes all related services
- Breaking out bilateral procedures when one code is appropriate
- Down coding a service in order to use an additional code when one higher-level, more comprehensive code is appropriate