Ohio Code 5164.46 – Electronic claims submission process; electronic fund transfers
(A) As used in this section, “electronic claims submission process” means any of the following:
Terms Used In Ohio Code 5164.46
- Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
- medicaid provider: includes a person or government entity applying for a provider agreement, a former medicaid provider, or both. See Ohio Code 5164.01
- Medicaid services: means either or both of the following:
(1) Mandatory services;
(2) Optional services that the medicaid program covers. See Ohio Code 5164.01
(1) Electronic interchange of data;
(2) Direct entry of data through an internet-based mechanism implemented by the department of medicaid;
(3) Any other process for the electronic submission of claims that is specified in rules adopted under section 5162.02 of the Revised Code.
(B) Not later than January 1, 2013, and except as provided in division (C) of this section, each medicaid provider shall do both of the following:
(1) Use only an electronic claims submission process to submit to the department of medicaid claims for medicaid payment for medicaid services provided to medicaid recipients;
(2) Arrange to receive medicaid payment from the department by means of electronic funds transfer.
(C) Division (B) of this section does not apply to any of the following:
(1) A nursing facility;
(2) An ICF/IID;
(3) A medicaid managed care organization;
(4) Any other medicaid provider or type of medicaid provider designated in rules adopted under section 5162.02 of the Revised Code.
(D) The department shall not process a medicaid claim submitted on or after January 1, 2013, unless the claim is submitted through an electronic claims submission process in accordance with this section.