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In preparation for the Oct. 1 launch of the new Provider Network Management (PNM) module, which will reduce administrative burden on providers, ODM is no longer accepting new provider enrollment applications through the MITS Provider Enrollment System as of 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 OhioRISE provider enrollment 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 downtime is also in place.
Where can I learn more about the new process?
On July 29, ODM released OhioRISE Provider Enrollment During System Downtime Guidance available on the Resources for Community Partners and Providers page of the OhioRISE webpage. You will find detailed information regarding the steps you should take to enroll as a Medicaid provider or enroll in OhioRISE provider specialties between Aug. 1 and Sept. 30.
Where can I direct my questions?
If you have questions about Ohio Medicaid provider enrollment, 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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We are excited to announce that the Provider Network Management (PNM) module Pre-Registration tool will go live on Aug. 15! An OH|ID is required to access the PNM module and this tool will give providers the option to pre-register for the PNM module and an OH|ID prior to launch. By taking a few minutes to pre-register for an account and create OH|ID logins between Aug. 15 and Sept. 23, providers can prevent delays to system access on Oct. 1.
As a reminder, the PNM module will replace the current MITS system and provide access to provider enrollment, prior authorizations, claims submission, centralized credentialing, provider self-service, and an enhanced provider directory.
To learn more about the PNM Module and Centralized Credentialing, visit the PNM & Centralized Credentialing page on the Next Generation website. You can also submit questions to the dedicated mailboxes: PNMCommunications@medicaid.ohio.gov or Credentialing@medicaid.ohio.gov.
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Beginning Dec. 1, 2022, the Next Generation managed care plans will provide Ohio Medicaid managed care members more personalized healthcare benefits, such as increased access to care coordination and care management supports, that will help address their individual healthcare needs.
To assist Ohio Medicaid managed care members in choosing which Next Generation plan is the best fit for their healthcare needs, the Ohio Department of Medicaid has introduced the Next Generation Health Plan Comparison document. The Next Generation Health Plan Comparison document provides an overview of the services that all Next Generation managed care plans provide, and specific value-added services provided by each individual plan.
All Ohio Medicaid managed care members can select a Next Generation plan at any time through Nov. 30.
Have additional questions about what actions Ohio Medicaid managed care members are encouraged to take? Visit www.ohiomh.com, or read on for answers to some of the most common questions.
Will Ohio Medicaid managed care members lose coverage?
In the coming months, Ohio Medicaid members will receive many communications about their healthcare coverage. It is incredibly important for you to ensure your contact information is up to date. Please carefully review all communications shared by ODM and follow the instructions provided to ensure continuity of coverage. Learn more here.
What actions are Ohio Medicaid managed care members encouraged to take to select a plan?
Ohio Medicaid encourages all managed care members to review and select the Next Generation plan that best fits their healthcare needs.
Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment ending Nov. 30.
What does this mean for current Ohio Medicaid managed care members who are also enrolled in the OhioRISE program?
OhioRISE enrollees will receive their behavioral health benefits through Aetna (the OhioRISE plan) and their physical health services through a separate managed care organization or fee-for-service Medicaid.
What does this mean for current Ohio Medicaid managed care members currently with Paramount Advantage?
Current Ohio Medicaid managed care members who do not select a plan will stay with their current plan, with the exception of Paramount members. Paramount Advantage Medicaid has been acquired by Anthem Blue Cross and Blue Shield (Anthem). Anthem is working with Paramount Advantage to continue providing your healthcare coverage and you will continue receiving healthcare coverage through Paramount Advantage until the Next Generation managed care plans begin providing healthcare coverage. At that time Anthem will be your Next Generation managed care plan. You do not need to take any action to begin receiving healthcare benefits through Anthem and there will be no disruption in your care. All Ohio Medicaid managed care members can select a different plan at any time until the end of open enrollment through Nov. 30.
What does this mean for Ohio Medicaid managed care members in a continuing plan?
Ohio Medicaid members do not need to do anything and will remain with their current managed care plan. Ohio Medicaid encourages all members to review the Next Generation plans available and select the plan that best meets their healthcare needs. Members can review and select the Next Generation plan that best fits their healthcare needs at any time through Nov. 30.
What does this mean for newly eligible Ohio Medicaid managed care members?
Individuals who are newly eligible for managed care, those who are currently in Medicaid fee-for-service not enrolled with a managed care plan, and those with a gap in eligibility of 91+ days will receive care paid for through Medicaid fee-for-service until Dec. 1 when they will be transitioned to an Ohio Medicaid Next Generation plan.
ODM will notify impacted members which plan they have been transitioned to. Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment through Nov. 30. Newborns and case additions will continue to be added to managed care plans as they become Medicaid eligible during this time.
How can an Ohio Medicaid managed care member select a Next Generation plan?
Managed care members can review their options using information in communications distributed by Ohio Medicaid and housed on the Medicaid Consumer website at www.ohiomh.com. Managed care members may select their plan at any time through Nov. 30, by contacting the Ohio Medicaid Consumer Hotline at 800-324-8680 or through the online portal at www.members.ohiomh.com.
What resources are available to Ohio Medicaid managed care members to help them identify which Next Generation plan best meets their healthcare needs?
- The Next Generation Health Plan Comparison document provides an overview of the services that all Next Generation managed care plans provide, and specific value-added services provided by each individual plan. The Health Plan Comparison is available on Medicaid Consumer website at www.ohiomh.com.
- The Find A Provider search tool can help members identify which Next Generation managed care plans their trusted providers are contracted – or “in network” – with.
- Each Next Generation managed care organization (MCO) has a member website that members can visit to learn more about that MCO’s Next Generation of Ohio Medicaid plan and their approach to serving Ohio Medicaid managed care members:
- Members can call the Medicaid Consumer Hotline at 800-324-8680 if they have additional questions about the Next Generation managed care plan options available.
When will Ohio Medicaid managed care members begin receiving services from their selected plan?
Ohio Medicaid managed care members will remain with their current managed care plan until Ohio Medicaid's Next Generation managed care plans begin providing healthcare coverage on Dec. 1.
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Important changes that may impact you as an Ohio Medicaid (ODM), Department of Developmental Disabilities (DODD), or Ohio Department of Aging (ODA) provider are coming, and we want to make sure you’re aware of them.
Beginning Aug. 1, 2022, the Ohio Department of Medicaid (ODM) will temporarily stop accepting provider enrollment applications as we transition to the new Provider Network Management (PNM) module. New providers should enroll by July 31 or plan to hold enrollment applications until Oct. 1. ODM can backdate enrollment after verifying the provider meets all eligibility criteria for the time period.
Due to the July 1, 2022, launch of the OhioRISE program, organizational or individual practitioners who will be providing services covered by the OhioRISE program may enroll with Medicaid and add OhioRISE provider specialties between Aug. 1 and Sept. 30, to begin providing and billing for services. For guidance on this process, please view the OhioRISE Provider Enrollment During System Transition Guidance available on the Resources for Community Partners and Providers page of the OhioRISE webpage.
Beginning Aug. 31, all provider demographic and agent maintenance update functionality will be closed for conversion of data in MITS. Enrolled providers should update their demographic information in MITS by Aug. 30 or plan to hold updates until Oct. 1. Please visit the following link to the MITS Secure Portal Login:
www.ohmits.com/prosecure/authtam/handler?TAM_OP=login&URL=%2F
Please make sure to add or update all practice locations and provider affiliations in advance of data conversion.
For more information visit:
Send questions to:
For providers certified by DODD, please click here to learn more and view important cut-off dates. For more information visit: www.DODD.Ohio.Gov
Send questions regarding provider certification to:
For providers certified by ODA, please click here to learn more. For more information visit: www.Aging.Ohio.Gov/certification-changes
Send ODA provider certification questions to:
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As you are likely aware, Ohio Medicaid is in the process of implementing our Next Generation program to focus on the individual rather than the business of managed care so that we can do better for the people we serve. One way we hope to achieve this vision is through the implementation of the Provider Network Management (PNM) module to reduce the administrative burden on providers.
Training and Learning Management System
In preparation for Stage 2 go-live (Oct. 1, 2022), we are offering a variety of training options including self-paced, virtual, and in-person training options. Absorb, the Learning Management System (LMS), is where you will access the self-paced training and sign up for the virtual and/or in-person sessions.
LMS Registration
Training sessions are scheduled to begin Aug. 1, and it is important that you create an account in the LMS to ensure you have access to all training sessions, answer forms, and PNM resources in advance. Click on the appropriate link below, based on your provider type, to access the LMS and follow the steps to create your account and register for training:
Questions
Please email OhioTrainingTeam@maximus.com with any questions regarding training sessions or additional information.
About the PNM and Centralized Credentialing
The PNM module and Centralized Credentialing program are part of the “Big 5” strategic initiatives being implemented within the Next Generation of Ohio Medicaid’s managed care program.
The PNM will replace the current Medicaid Information Technology System (MITS) provider enrollment subsystem provider portal. This module will be implemented along with Centralized Credentialing, which is a state-level single centralized provider credentialing process. These initiatives will modernize the system by streamlining processes and reducing administrative burdens for providers. For more information about PNM and Centralized Credentialing, visit the Managed Care website.
Thank you in advance for your consideration and for your support of ODM’s Next Generation vision.
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