The Ohio Department of Medicaid (ODM) hosted the Next Generation Ohio Medicaid Program Provider Overview Webinar, which covered the exciting changes Ohio Medicaid providers can expect, including an overview of the transition to the Ohio Medicaid Enterprise System (OMES) modules, training plans and dates, and where providers can receive communications from ODM throughout the Next Generation transition and staggered implementation. Please view a recording of the webinar and corresponding slide deck.
We encourage you to read on for answers to the five most frequently asked questions! The full FAQ can be found here and by visiting the Resources for Providers page.
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Centralized Credentialing and OH|ID
1. Is an OH|ID the same as a Medicaid Information Technology System (MITS) login?
The OH|ID is separate from your existing MITS sign-on. If you do not already have an OH|ID, you will need to create this either during the pre-registration period from August 15 to September 23 or register on or after October 1. For more information about OH|ID and pre-registration please visit PNM Pre-Registration Tool | Ohio Medicaid Managed Care.
2. Will groups be able to obtain an OH|ID for their providers and update on their behalf?
Based on feedback received in recent webinars and training sessions, we are excited to announce the addition of a new “enrollment agent” role within the Provider Network Management (PNM) module. This new role will be able to update provider information and submit revalidations on behalf of a provider. Like the agent role, the enrollment agent will be assigned by the provider administrator.
3. When can I submit a new provider enrollment application?
On August 1, the Ohio Department of Medicaid (ODM) temporarily stopped accepting provider enrollment applications as we transition to the new Provider Network Management (PNM) module. New provider enrollment applications are on hold until October 1. ODM can backdate enrollment after verifying the provider meets all eligibility criteria for the time period.
4. How long will providers have access to Medicaid Information Technology System (MITS) after the go-live?
Providers will only be able to access Medicaid Information Technology System (MITS) through the Provider Network Management (PNM) module effective October 1. Once logged on to PNM, providers will be automatically redirected to MITS functionality for secure portal functions that are still within MITS. After December 1, all remaining MITS functionality will be fully integrated within the PNM and the Electronic Data Interchange (EDI) if utilizing a trading partner.
5. Should MyCare claims be submitted through the Provider Network Management (PNM) module?
No, MyCare claims should continue to be directly submitted to the applicable payer, either Medicare or the MyCare managed care plan.
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ODM is excited to announce that SPBM Web Portal Training registration is now open. This training is for prescribers, prescriber support staff, pharmacists, and pharmacy support staff. Please join to learn the difference between the public and secure portals, including how to register for the latter.
The public-facing SPBM web portal provides instant access to reference materials such as the Unified Preferred Drug list (UPDL) and criteria, the Preferred Diabetic Supply list, the Specialty Drug list, and Quantity Limits list to assist with prescribing medications to Ohio Medicaid managed care members.
The secure SPBM web portal provides a way to check Ohio Medicaid managed care member eligibility, submit pharmacy prior authorizations, and view pharmacy claims and prior authorization history. The portal also includes a secure web chat to quickly speak with the SPBM help desk.
Registration instructions can be found by navigating to https://spbm.medicaid.ohio.gov and selecting the provider tab. Under the provider tab, you will find the associated menu for “SPBM Web Portal Training.” The provider trainings dates are as follows:
- Prescriber and prescriber support staff training begins September 6.
- Pharmacy and pharmacy support staff training begins September 19.
If you have any questions regarding SPBM web portal training, please email OH_MCD_PBM@gainwelltechnologies.com.
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Beginning Oct. 1, the Ohio Department of Medicaid (ODM) will resume provider revalidation for providers with a typical five-year provider agreement. ODM will send notices to providers via the Provider Network Management (PNM) module 120 days before their revalidation date. |
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Providers whose revalidations were paused due to the COVID-19 Public Health Emergency will have their past revalidation due dates recalculated following guidance from the Centers for Medicare and Medicaid Services (CMS). Providers will always receive 120-day notice before revalidation due dates. Please ensure that your email address and mailing address are updated in MITS before Aug. 30. After this date, the next opportunity to update your information will be Oct. 1 in PNM.
With the implementation of ODM’s Centralized Credentialing Strategic Initiative, ODM is matching revalidation due dates with providers’ recredentialing due dates. Providers who are subject to credentialing will no longer have five-year Medicaid agreements. Instead, all credentialed providers will have three-year Medicaid provider agreements to align their revalidation dates and recredentialing dates.
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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.
The Ohio Department of Medicaid (ODM) has temporarily paused all provider enrollment and maintenance activities during this transition. On October 1, provider enrollment and maintenance-related activities will resume and be submitted using PNM. Organizational or individual practitioners who will provide services covered by the OhioRISE program and behavioral health community providers may enroll with Medicaid and add OhioRISE provider specialties between August 1 and September 30 to begin providing and billing for services. The guidance was updated on August 31, please view the Updated Community BH and OhioRISE Provider Enrollment During System Transition for direction on this process.
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 (October 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
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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