LAW
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Ohio Laws and Rules
(A) The Ohio department of job and family services (ODJFS) shall make payment for covered services by state warrant or electronic funds transfer (EFT), directly to the provider or authorized agent within thirty days of receipt of a claim that complies with claim submission specifications in accordance with rule 5101:3-1-19 of the Administrative Code.
(1) Payment for covered services shall not be made if the provider has a credit balance to which the entire payment is to be applied. A partial payment shall be made when only a portion of a payment needs to be applied to satisfy a credit balance.
ODJFS is not required to make payment or partial payment to a nursing facility or intermediate care facility for the mentally retarded on or after the date the nursing facility or intermediate care facility for the mentally retarded changes ownership, closes, or upon voluntary or involuntary termination from the medicaid program, until completion and final adjudication of reviews or audits.
(2) The date of payment shall be considered the date payment is issued by the office of budget and management or the date of the EFT notification.
(3) EFT is available to the medicaid provider community through ODJFS. EFT allows the provider’s financial institution to deposit the provider’s medicaid payments into provider designated accounts. ODJFS does not charge for this service.
(B) Payment of interest applies only to a clean claim. “Clean Claim” means a claim that can be processed by ODJFS without obtaining additional information from the provider of the service or from a third party. A claim completing the adjudication process with an assigned disposition of either “pay” or “pay and report” is considered to be a clean claim.
(C) Provisions for the payment of interest:
(1) If ODJFS does not make payment, as evidenced by a warrant, within thirty days of receipt of a clean claim as defined in paragraph (B) of this rule, then interest on the amount due shall begin to accrue from the thirty-first day forward until payment is made.
(2) The amount of the interest charge that remains unpaid at the end of any thirty-day period after the required payment date shall be added to the principal amount due. Thereafter, the interest charge shall accrue on the principal amount due plus the added interest charge.
(3) The interest charge shall be at the rate per calendar month that is equivalent to one-twelfth the rate per year prescribed by section 5703.47 of the Revised Code for the calendar year that includes the month for which the interest charge accrues.
(4) The interest will be paid when the interest calculation is greater than or equal to ten dollars per claim.
(5) Claims submitted for adjustment shall not be eligible for interest payments though they may be eligible for credit or debit adjustment. Any interest incurred on an original claim will be included in the adjusted reimbursement amount. Additional interest shall not be paid based upon the length of time required to adjudicate the adjustment transaction.
(6) Claims submitted for hold and review in accordance with rule 5101:3-1-27 of the Administrative Code shall not be eligible for interest payments.
(D) Claims being resubmitted for payment that were previously returned to the provider for correction will be considered new claims for the provisions of interest payments.
Effective: 05/23/2007
R.C. 119.032 review dates: 03/06/2007 and 05/01/2012
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01, 5111.02
Prior Effective Dates: 6/3/83, 2/1/84, 10/1/84, 7/1/85 (Emer), 9/30/85, 10/1/87, 7/1/02