|
The Ohio Department of Medicaid (ODM) continues to implement new initiatives and improvements to achieve the program’s mission to focus on the individual and improve the provider experience. As an extension of this effort, we will implement new features in Ohio Medicaid Enterprise System (OMES) modules. Providers will see and utilize these new features in the Provider Network Management (PNM) module beginning on June 30, 2024. Check out the information below to learn more about the benefits providers and other PNM users will experience as a result of this implementation.
 |
|
The new OMES features in the PNM will increase visibility for providers of claims submitted by trading partners, streamline fee-for-service (FFS) claims and prior authorizations submission, improve self-service functions and access to financial documents. The improvements will allow providers and other PNM users to:
-
Complete direct data entry for FFS claims, prior authorization processes, and searches, and complete other administrative activities in the PNM module without being rerouted to Medicaid Information Technology System (MITS).
-
Complete claim adjustments and voids in the PNM for any FFS claims, whether they are submitted by direct data entry in the PNM or by a trading partner in the Electronic Data Interchange (EDI).
-
Receive one remittance advice for fee-for-service claims whether they are submitted by direct data entry in the PNM or by a trading partner in the Electronic Data Interchange.
-
Find 1099 forms and other financial documents in the PNM without needing to call the Fiscal Intermediary helpdesk.
-
Look up member eligibility and hospice enrollment within the PNM, rather than being rerouted to MITS, which will streamline and simplify the processes.
The new features described above impact FFS claims and prior authorizations. There will not be changes to managed care claims and prior authorizations as part of this implementation.
|
 |
|
Where can providers find training and resources?
|
 |
|
Will this implementation impact claim submission?
In the coming weeks, we will also provide information about impacts to claims submission and prior authorizations in the period leading up to the upcoming implementation.
We appreciate your support of the Ohio Department of Medicaid as we take the next step in realizing the Next Generation program mission. As always, if you have any questions, please contact us.
|
Return to Top
The Ohio Department of Medicaid in partnership with Maximus, the Provider Network Management (PNM) module vendor, is offering a variety of training sessions focused on the new features coming to the Ohio Medicaid Enterprise System. Providers will see and utilize these new features in the PNM module beginning on June 30. For a description of the benefits providers and other PNM users will experience please see our Providers can now register for the PNM module training sessions, in the Learning Management System (LMS), Absorb. We will begin training sessions May 13 and you can find the complete schedules for the months of May, June, and July on the Next Generation website.
Learning Management System registration
In preparation for the June 30 implementation, ODM is offering multiple training options including self-paced e-learning and virtual instructor-led training options. Absorb, the LMS, is where you will access the self-paced e-learning and register for the instructor-led sessions. If you do not have an existing account in the LMS, it’s important that you create one to ensure you have access to all training sessions, recordings, and training guides for the new system features. Access the job aid and follow the steps to create your account and register for training.
Training module topics will include the following:
- Fee-for-service (FFS) dental claims submission and search.
- FFS institutional claims submission and search.
- FFS professional claims submission and search.
- FFS prior authorization submission and search.
- FFS hospice member enrollment.
- Medicaid member eligibility inquiry.
- Provider financial document access (e.g., claim transaction history, 1099, remittance advice).
For more information
To learn more about the PNM module and Centralized Credentialing, visit the PNM and Centralized Credentialing page on the Next Generation website. If you are experiencing any technical issues accessing the PNM module or have specific questions, please contact Medicaid’s Integrated Helpdesk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. The IHD is open Monday-Friday, 8 a.m.-4:30 p.m. Eastern time.
|
Return to Top
The Ohio Department of Medicaid is conducting a series of MyCare Ohio program community input sessions to hear about your experiences navigating the current MyCare Ohio program, other Fully Integrated Dual-Eligible Special Needs plan (FIDE-SNP) models, and the members you serve. The session scheduled for Tuesday, May 7 for long-term care providers has been canceled. We apologize for the inconvenience.
To learn more about the MyCare Ohio program and community input sessions and view the updated schedule, please visit the MyCare Ohio program webpage.
|
Return to Top
“This is our time to meet the moment. Our time to do the hard things that matter and will make a lasting difference for our children and their future.”
– Ohio Governor Mike DeWine
On April 10, Governor DeWine delivered his 2024 State of the State where he highlighted the work his administration and the General Assembly have accomplished together, and outlined new initiatives intended to help Ohio’s children thrive. The Ohio Department of Medicaid is proud that OhioRISE was one of the featured initiatives, described as a lifeline for children with extremely complex behavioral healthcare needs.
Watch the entire State of the State here.
 |
|
OhioRISE program highlights
OhioRISE is a long-term commitment to building capacity for community-based care that keeps children and youth close to their homes and caregivers. Since launching in July 2022, the OhioRISE program has:
- Enrolled 31,656 members and served more than 3,000 children in foster care since launching in July 2022.
- Deployed new services such as flex funds and respite, matching the continuous work and creativity needed to treat and care for children with intensive behavioral health needs.
- Expanded connections within local communities to extend and strengthen a coordinated and comprehensive responses to better serve children who might otherwise be “bounced around” from one system to another.
- Trained more than 700 care coordinators that are working at local care management entities (CME) to provide wraparound coordination, which is when child and family-focused teams of caring adults come together to develop creative solutions tailored to each young person’s circumstances and help families navigate and access care.
|
 |
|
Who can benefit from the OhioRISE program?
Children and youth who:
- Have multiple needs that result from behavioral health challenges.
- Have needs that involve multiple state and local supports or are at risk for deeper system involvement.
- Are at risk of out-of-home placement or are returning to their families from out-of-home placement.
|
 |
|
Who is eligible for the OhioRISE program?
Children and youth who may be eligible for OhioRISE must meet each of the following criteria:
|
If you know a youth and family struggling with mental health challenges, tell them to visit the CANS referral resource and contact the OhioRISE mailbox with questions.
Return to Top
|
