In preparation for the June 30 New Features Implementation, now is a great time to use the self-service feature and review role assignments in the Provider Network Management (PNM) module. All PNM users have either an “Administrator” or “Agent” role giving access to various functionality in the system. Administrators assign specific agent roles to others in their organization. If you need a refresher or assistance, please visit the Agent Assignment and Actions quick reference guide for detailed instructions on assigning agent roles.

The launch of the additional PNM module features will increase visibility for providers of claims submitted by trading partners, streamline fee-for-service (FFS) claims and prior authorizations submission, and improve self-service functions and access to financial documents. The Fiscal Intermediary will process and adjudicate all FFS claims and prior authorizations. PNM users who submit FFS claims via direct data entry, check member eligibility, or submit prior authorizations among many other actions, will access all the features directly in the PNM module instead of being redirected to the Medicaid Information Technology System (MITS).

For more information

For technical support with administrator role changes please contact PNMSupport@medicaid.ohio.gov. For assistance on how to assign agent roles contact ODM’s Integrated Helpdesk (IHD) at 800-686-1516 and follow the prompt for Provider Enrollment, or email IHD@medicaid.ohio.gov. Representatives are available Monday through Friday 8 a.m.-4:30 p.m. Eastern time.

In May, we announced the release of the Next Generation MyCare Request for Applications (RFA). This RFA is for managed care entities interested in becoming Next Generation MyCare managed care plans for Ohioans who are dually eligible for Medicaid and Medicare. The selected plans will be an essential piece in improving the health and lives of Ohioans. This RFA remains open, and we encourage all eligible managed care entities to apply.

All potential applicants are required to notify ODM of their intent to submit a response by June 26 at 4:00 p.m. ET by emailing IntentiontoBid@medicaid.ohio.gov. Further details are noted in the RFA.

Like any procurement of this size, this procurement has significant guardrails regarding communications about the procurement and the program.

ODM must adhere to federal and state procurement requirements and appropriate safeguards to ensure a fair process and reduce the risk of post-award challenges. As a result, ODM cannot:

• Share details related to RFA content, release certain dates, timelines, responses received, and/or award prior to official public announcements.
• Communicate design discussions and decisions related to the MyCare structure beyond what is stated in the RFA.

At this point in time, ODM is in the “quiet period” for the Next Generation MyCare procurement, which dramatically limits the information available to share on an individual basis. All information ODM releases regarding the Next Generation MyCare procurement must be at equal opportunity of access for potential bidders, preventing any compromise of the procurement.

It is ODM’s commitment to remain as communicative and transparent as possible through the remainder of the procurement process, while still maintaining the integrity of the Next Generation MyCare procurement. ODM will not be able to answer questions from members of the public or potential bidders regarding the Next Generation MyCare program, but general updates and announcements will be posted on the MyCare Ohio webpage on Medicaid.ohio.gov.

Resources on procurement regulations can be found in the State of Ohio Procurement Manual.

For additional information about the RFA or procurement process, visit the MyCare Ohio webpage on Medicaid.ohio.gov.

The Ohio Department of Medicaid, in partnership with Maximus, the Provider Network Management (PNM) module vendor, is excited to share that we are continuing our provider awareness and training efforts around the new features implemented in the Ohio Medicaid Enterprise System. Providers will see and utilize these new features in the PNM module beginning on June 30. There is still time to register for the PNM new features training. The training schedule is available on the PNM and Centralized Credentialing page. Below you will find how to register and a list of training topics. 

Learning Management System registration  

Access the Absorb learning management system job aid and follow the steps to create your account and register for training. Absorb is where you can access virtual and self-paced training sessions. If you do not have an Absorb account, you must create one to access all training sessions, answer forms, and view a variety of PNM module resources. 

Training module topics include:  

• 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).