The Ohio Department of Medicaid (ODM) continues to implement new initiatives and improvements to achieve the Next Generation program mission to focus on the individual and improve the provider experience. On June 30, ODM will implement new features in the Ohio Medicaid Enterprise System (OMES). Providers will see and use these new features in the Provider Network Management (PNM) module.

What do I need to know about the June 30 implementation?  

The new OMES features in PNM 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. The improvements will allow providers and other PNM users to: 

• Complete direct data entry for FFS claims and prior authorizations, conduct claims searches, and complete other administrative activities in the PNM module without being rerouted to the 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 via the Electronic Data Interchange.  
• Receive one remittance advice for FFS claims whether they are submitted by direct data entry in the PNM or by a trading partner via the Electronic Data Interchange.  
• Find future 1099 forms and other financial documents in the PNM without needing to call the Integrated Helpdesk (IHD). To retrieve 1099 forms for past tax years providers will need to call the IHD.   
• Look up member eligibility within the PNM, rather than being rerouted to MITS, which will streamline and simplify the process.  
• Look up hospice enrollment within the PNM, rather than being rerouted to MITS. 

The new features impact FFS claims and prior authorizations. There are no changes to managed care claims and prior authorizations as part of this implementation.  

Where can providers find training and resources?  

We understand that this is a big change, and we appreciate your contributions that have made the Next Generation program possible. ODM developed resources to help providers with this implementation. We encourage you to read and share the following: 

• View the June 30 New Features Implementation Overview document to learn what this change means for providers and PNM users. This resource also includes information about where providers should go for questions about OMES-submitted claims, prior authorizations, and other administrative processes. 
• View the Who to Contact for Help document to learn who providers should contact if they need assistance. Most questions about this implementation should be directed to the Integrated Helpdesk at (800) 686-1516.  
• Review the June 30 New Features Implementation Frequently Asked Questions (FAQ) document for answers to some of the most common questions about the implementation. 
• Review the PNM module FAQ document for more information on PNM functionality.  
• Visit the Implementation Training and Resources page on the Next Generation website to learn more about training, and other available resources. 

Do you have questions?  

If you have questions related to OMES-submitted claims, prior authorizations, or other administrative processes, contact the 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.  

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).

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. If you currently provide services through MyCare Ohio or are interested in becoming a MyCare Ohio provider, please join us during one of our upcoming sessions.  

To learn more about the MyCare Ohio program and community input sessions and view the schedule, please visit the MyCare Ohio program webpage.

The Ohio Department of Medicaid (ODM) is seeking stakeholder feedback to guide our efforts to better serve young people with behavioral health challenges and their caregivers throughout communities across the state. We understand that the OhioRISE program will continue to evolve to mature and address changing needs.  

We ask you to raise your voice for OhioRISE by either completing this form or sending us an email to OhioRISE@medicaid.ohio.gov, where you can express your ideas for improving OhioRISE. 

Over the past five years, ODM and our partners have been working together to begin shifting the system of care to keep more youth and families together, support young people and their caregivers with care coordination, and build up access to new services to support the complex mental health and substance use needs of the young people in our program. We have found that this long-term work requires tenacity, passion, and above all else deep collaboration among partners across our child-serving systems. OhioRISE continues to rely on stakeholder input to inform the evolution of our program. 

Thank you for continuing to help us provide family-centric programs that reach every eligible child and youth who needs us statewide.