Dear Medicaid Providers and Stakeholders,
Over the past year, Ohio Department of Medicaid (ODM) has prepared for and successfully launched many components of the Next Generation Ohio Medicaid program. Our implementation has consistently followed two of our key Next Generation commitments – to focus on the individual and improve the provider experience. To meet these commitments, on July 1, ODM implemented OhioRISE (Resilience through Integrated Systems and Excellence) and on October 1, we implemented the Single Pharmacy Benefit Manager (SPBM) and Centralized Credentialing for providers. The feedback has been clear about the significant benefits members and providers have experienced because of these new program changes.
Our focus has been and continues to be on implementing new components and improvements as they are fully ready to support achieving our mission. ODM remains committed to listening to members, providers and managed care plan partners, and we have taken a hands-on approach to resolving implementation issues that have been experienced by providers. Leading up to our next implementation, we have been actively seeking input from stakeholders and conducting testing of all systems.
What does this mean for providers?
Based on the feedback we have received and our commitment to carefully transitioning, we will not implement the new Next Generation managed care plans and the full Ohio Medicaid Enterprise System (OMES) launch on December 1. The new lineup for implementation is as follows:
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On February 1, 2023, ODM will launch the Next Generation managed care plans and program requirements, including exciting improvements that will support members in accessing the healthcare services and supports they need. ODM will also implement the new Electronic Data Interchange (EDI), increasing transparency and visibility of member care and services.
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Subsequently, ODM will fully launch OMES modules to provide streamlined processes for claims, prior authorizations, and other administrative tasks for providers.
Providers should continue conducting business as you do today on and after December 1 – including the processes, procedures and systems used today to submit claims, prior authorizations and complete other administrative functions. ODM will provide more information about the upcoming implementation for members and providers in the coming weeks.
Thank you for your continued partnership and support of the Next Generation Ohio Medicaid program!
Please reach out to the Next Generation mailbox with questions. Thank you for your continued partnership and support of the Next Generation Ohio Medicaid program!
Ohio Department of Medicaid
