 New OhioRISE Provider Enrollment Guidance is Effective August 1
In preparation for the Oct. 1 launch of the new Provider Network Management (PNM) module, which will reduce administrative burden on providers, ODM will not accept new provider enrollment applications through the MITS Provider Enrollment System starting Aug. 1.
In recognition of the ongoing enrollment of OhioRISE members and the needs to support and build the system of care related to the July 1 launch of the OhioRISE program, ODM and Aetna Better Health of Ohio (Aetna) partnered to develop a process for during this time. Organizational or individual practitioners who will be providing OhioRISE services can be screened for enrollment so that they can provide and bill for services. A new process for enrolled Medicaid providers who wish to add OhioRISE provider specialties during the provider enrollment system transition will also be in place.
ODM has released OhioRISE Provider Enrollment During System Transition Guidance available on the Resources for Community Partners and Providers page of the OhioRISE webpage. Learn more about the new OhioRISE provider enrollment processes you should follow during the provider enrollment system transition below!
How do I enroll as an OhioRISE provider during the provider enrollment system transition?
If you are a provider seeking to contract with Aetna who also needs to enroll as an Ohio Medicaid provider, you must reach out to Aetna at ohrise-network@aetna.com. An Aetna representative will assist you in completing necessary forms and identifying and gathering relevant information to accompany your application. Aetna will send all documentation to ODM Provider Enrollment staff, who will verify that necessary information has been received before completing a screening against required database resources. Please note that ODM will not accept paper applications sent by providers.
ODM will take the following actions according to the month in which you/your organization passed screening to be enrolled.
During August:
If you/your organization successfully passes screening to be enrolled before Aug. 31, ODM will manually add your provider information in MITS and complete the enrollment to make you an active provider. ODM will issue a welcome letter directly to you and will copy Aetna on the notification email you will receive.
Through this process, the Provider Master File (PMF), which is used by the OhioRISE plan and the managed care organizations (MCO) to ensure providers are actively enrolled with Medicaid, will be updated to include your provider enrollment. You may begin submitting claims to the relevant payer upon addition to the payer’s network.
If you/your organization does not successfully pass screening, ODM will issue you appropriate notice with due process rights and copy Aetna on such correspondence.
During September:
If you/your organization successfully passes screening, you will be notified via email. The email will include the expected enrollment effective date based on the application/certification date, the provider type, and relevant provider specialty or specialties. ODM will not issue a welcome letter or a Medicaid Provider number.
The PMF will be updated when the PNM module goes live Oct. 1, 2022. Your provider information, which will include name, NPI, service address, group affiliations, enrollment date, provider type, and provider specialty or specialties, will be added to a supplemental file that will be shared with Aetna and the MCOs on a weekly basis. You may begin submitting claims to the relevant payer upon addition to the payer’s network.
If you/your organization does not successfully pass screening, ODM will issue you appropriate notice with due process rights and copy Aetna on such correspondence.
During October:
Effective Oct. 1, 2022, all provider enrollment applications must be submitted using Ohio Medicaid’s new PNM module, and ODM will begin screening new applications submitted in the PNM provider enrollment system. After its implementation, the PNM module will be the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service.
ODM will manually enroll providers screened during September in the PNM (with a backdated effective date to match the application date) and issue the welcome letter and the Ohio Medicaid Provider ID.
How do I add OhioRISE specialties to my active enrollment during the provider enrollment system transition?
ODM requires that providers add a provider specialty to their provider enrollment type in order to bill for some new and enhanced services under the OhioRISE program and as part of the Next Generation of Ohio Medicaid. If you are a currently enrolled Medicaid provider who wishes to add an OhioRISE provider specialty to your enrollment, please follow the below guidance according to the month in which you will make your request:
During August:
If you are a provider who already has an Ohio Medicaid Provider ID and need to add a specialty, update your affiliation or add a new credential to your Medicaid enrollment to bill for services to OhioRISE members, you may continue to request the addition of the specialty following the procedures outlined in the OhioRISE Provider Enrollment and Billing Guidance. Specialties added following this process will be reflected on the PMF and providers may begin submitting claims to the relevant payer upon addition to the payer’s network.
During September:
If you are a provider who already has an Ohio Medicaid Provider ID and need to add a specialty to your Medicaid enrollment to bill for services to OhioRISE members, please reach out to Aetna at ohrise-network@aetna.com to request the addition of the relevant specialty and include the NPI, the Ohio Medicaid Provider ID, and attach required documentation as outlined in the OhioRISE Provider Enrollment and Billing Guidance.
During October:
Effective Oct. 1, 2022, all provider specialty requests must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) module.
ODM will manually add the additional specialty or specialties to providers screened during September in the PNM with a backdated effective date to match application date and issue the welcome letter and the Ohio Medicaid Provider ID. Providers may submit claims to the relevant payer upon addition to the payer’s network.
For Ohio Medicaid provider enrollment questions, please contact ODM’s Integrated Help Desk (IHD) at 800-686-1516, which is available Monday through Friday 8 a.m.-4:30 p.m. For Aetna/OhioRISE plan contracting questions, please contact Aetna’s OhioRISE Provider Experience Help Line at 833-711-0773 (option 2), which is available Monday through Friday 7 a.m.-8 p.m.
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