Oklahoma City Clearinghouse
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Update: Ohio Medicaid One Front Door, new reporting starting Sept. 18, 2023
Incident
Report for Optum OKC Clearinghouse
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Monitoring
When Optum implemented the unique ODM (Ohio Department of Medicaid) “ODM one front door” claims routing configuration in Feb. 1, 2023, the payer changed the way that they report claim level rejections. ODM reports claim level rejections on a 999 Functional Acknowledgement instead of a 277CA Claims Acknowledgement. Starting on September 18, 2023, Optum will be passing pertinent rejection information from these 999 files to our submitters via the following reporting methods:
• SR (Human Readable Standardized Payer Report)
• SF (Data File Standardized Payer Report)
• FX (Recreate Notification Report)
As a reminder, providers need to access the Provider Network Management link to add NPI affiliations. Failure to complete this step will result in claim rejections.
• The messages returned to the provider for not completing this step are as follows:
o 7 - INVALID CODE VALUE|REF ELEMENT 2 – xxxxxxxxx
Where xxxxxxxxx represents the NPI that has not been registered
o 8 - SEGMENT HAS DATA ELEMENT ERRORS|2010 REF|
Ref#572800
• SR (Human Readable Standardized Payer Report)
• SF (Data File Standardized Payer Report)
• FX (Recreate Notification Report)
As a reminder, providers need to access the Provider Network Management link to add NPI affiliations. Failure to complete this step will result in claim rejections.
• The messages returned to the provider for not completing this step are as follows:
o 7 - INVALID CODE VALUE|REF ELEMENT 2 – xxxxxxxxx
Where xxxxxxxxx represents the NPI that has not been registered
o 8 - SEGMENT HAS DATA ELEMENT ERRORS|2010 REF|
Ref#572800
This incident affects: Institutional, Professional, Dental, Real-Time, and Batch.