Ohio Medicaid Tort Recovery Unit Shares Automation Improvements Amid Delays
For the past 18 months, OAJ has advocated tirelessly to address the significant delays in claims processing caused by the Ohio Department of Medicaid’s (ODM) “Next Generation” technological overhaul.
Now, ODM’s Tort Recovery Unit reports that it has begun automating claims processing after nearly two years of delays. According to the Tort Recovery Unit, new claims data will be automatically loaded into the Meistro/Solaris+ systems, automating the workflow for processing within an internal 30-day service level agreement (SLA). ODM and Solaris+ are now aiming to clear the backlog by February 2025.
The Unit was originally created to streamline plaintiff repayment to ODM for claims that are ruled the responsibility of wrongdoers in civil suits. While OAJ staff and leadership collaborated constantly to improve the system between 2019 and January 2023, the imperfect yet responsive system was disrupted after ODM launched “Next Generation Ohio Medicaid.”
This rollout, a major overhaul of the state’s health insurance technology backbone, caused widespread issues, including manual claims processing and disrupted communication between Medicaid, managed care companies, and healthcare providers.
As a result, the Tort Recovery Unit’s system could no longer effectively exchange health care records, forcing case workers to consolidate medical and financial data manually. This caused significant delays in issuing final lien letters, frustrating Ohio attorneys and tort victims alike. In essence, the new Medicaid technological infrastructure no longer spoke one language.
Since early 2023, OAJ leaders have engaged with ODM to seek improvements but struggled to trust in swift resolutions. Despite this, recent updates indicate automation has been restored, and last week unit leaders set expectations for improved turnaround times.
The OAJ recommends that attorneys working with the Tort Recovery Unit, follow new protocols:
■ First, review the interim lien and ensure all claims are present.
■ Then, input the last date of treatment (LDOT) before requesting a final lien.
“Please remember, caseworkers are looking for a payment made on that LDOT,” ODM instructed OAJ. “Once the LDOT is entered, it will be off-ramped to a caseworker for review.”
All final liens must be reviewed manually to verify the LDOT and ensure no related claims are missing. For initial or updated interim liens, attorneys can generate these directly through the portal after reviewing the associated claims.
OAJ remains cautiously optimistic about these updates. While the automation of the system is promising, we’ll believe the problems are solved once our members see faster lien resolution. ODM has also provided a “Best Practices and Reminders” document to help attorneys and paralegals avoid common issues, and we encourage you to share it with your colleagues and staff. According to Brad Ingraham, Chief Executive Officer and Director of Government Affairs Ohio Association for Justice, “More time and work is needed, but OAJ will continue to advocate at ODM on your behalf.”
