ODM Announces Updates on Electronic Pregnancy Risk Assessment Form

In a message, the Ohio Department of Medicaid (ODM) thanked those who have been working to increase the electronic submission of a critical component of Medicaid's Maternal and Infant Support Program--the Pregnancy Risk Assessment Form (e-PRAF).

Changes in OAC 5160-1-60, effective July 1, 2021, increased the fee-for-service rate for electronic submission from $12.10 to $90 to recognize and support providers in their use of the electronic form. ODM has since become aware that a system modification required to implement the e-PRAF rate increase is using different coding than what was originally communicated and published in appendix DD to the Medicaid payment rule (OAC 5160-1-60). This notice only applies to fee for service. 

Corrected coding guidance is reflected below.

 

 

Original Coding Guidance

Corrected Coding Guidance

Rate

Electronic PRAF

H1000 + TH modifier

H1000 + 33 modifier

$90

Non-Electronic PRAF

H1000

n/a

$12.10

ODM will make a correction to the Medicaid payment rule appendix DD for a Jan. 1, 2022, filing and notify the managed care plans of this correction. All providers should:

  1. Adjust any fee-for-service claims for e-PRAFs with dates of service July 1, 2021, or later to reflect the corrected modifier in order to receive the correct reimbursement rate.
  2. Submit any new fee-for-service claims for e-PRAF using the corrected coding information outlined above.
  3. Review communications from managed plans regarding possible changes to their existing coding guidance for e-PRAFs.