Effective October 20, Next Generation Medicaid managed care organizations (MCO), the OhioRISE plan, and MyCare Ohio plans must use provider data from Ohio Medicaid’s Provider Network Management (PNM) module as it is the official system of record. To ensure the provider data sent from the PNM to the managed care entities (MCE) is accurate, it is imperative that your records are updated within the PNM module.If your data in the PNM module does not match your data on the submitted claim, your claims will be denied for payment.
Actions needed by you as a provider or a trading partner
Check that all data submitted on a claim and within the PNM module (e.g., addresses, affiliations, specialties, locations) is accurate and up to date.
Continue to update data as changes occur. MCEs will use this information as the system of record moving forward.
The MCEs download a complete extract of the Provider Master File (PMF) that includes all provider data daily.
For more information
For technical support or assistance, contact Ohio Medicaid’s Integrated Helpdesk (IHD) at 800-686-1516 and follow the prompts for Provider Enrollment (option 2, option 2) or email IHD@medicaid.ohio.gov. Representatives are available Monday-Friday, 8 a.m.-4:30 p.m. Eastern time.
Feel free to distribute the information contained within this update to your colleagues, organization's members, or with anyone who you think might find it useful. We want all Ohioans to know what is going on with ODM's strategic initiatives.
Please also encourage anyone who you think might be interested in receiving similar updates to subscribe to the ODM Press.
Connect With Us
Our email address will remain active through transition to and implementation of Ohio Medicaid's next generation program! We are always open to your ideas and feedback. To view our past newsletters, please visit our website here.
