On June 30, the Ohio Department of Medicaid implemented new features in the Ohio Medicaid Enterprise System that streamline fee-for-service (FFS) claims and prior authorization submissions. Now the Fiscal Intermediary vendor Gainwell Technologies pays FFS claims on behalf of Ohio Medicaid. With this enhancement providers must add or update their electronic fund transfer (EFT) information and physical address in the Provider Network Management module to receive EFT payments.
For step-by-step instructions on how to complete these actions in the Provider Network Management module please see the following quick reference guides.
If you have questions related to OMES-submitted claims, prior authorizations, or other administrative processes, email IHD@medicaid.ohio.gov or contact the IHD at 800-686-1516. The IHD is open Monday-Friday, 8 a.m.-4:30 p.m. Eastern time.
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The Ohio Department of Medicaid (ODM), 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. Training is scheduled for August 7 - 21, and the training schedule is available on the PNM and Centralized Credentialing page. Below, you will find instructions on how to register and a list of topics covered in each session.
Registration steps for enrolling through the learning management system
Access the Absorb, Maximus's learning management system to register for the training. If you do not have an Absorb account, you must create one to access all training sessions, answer forms, and view various PNM module resources. For help, please see our job aid and follow the steps to create your account and/or register for training.
- Provider Administrator User (PNM Dashboard/Homepage)
- Provider Administrator Role (Application)
- Provider Agent Role
- Individual Practitioner Updates & Revalidations
- Group/Organization Updates & Revalidations
- Managing and Updating Affiliations
- Behavioral Health Provider Updates & Specialty Changes
- Behavioral Health Provider Type Changes
- Fee-for-Service Claim Search & Submission
- Fee-for-Service Prior Authorization Search & Submission
Note: Additional session details are available within the Absorb course listing.
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 technical issues accessing the PNM module or have specific questions, please contact the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov. The ODM Integrated Helpdesk is open 8:00 a.m.-4:30 p.m. Monday-Friday, Eastern time.
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MyCare Ohio is the managed care program designed for Ohioans who receive both Medicaid and Medicare benefits. The MyCare Ohio program integrates Medicaid and Medicare benefits into one program, coordinated by a managed care plan.
On this page, you can find updates and an overview on the Next Generation MyCare program, which is regularly updated to provide the most up to date information.
For questions about the program or help finding your local county office, refer to the resources on the right side of the page. We also added resource boxes just below the contact information on the right side of the webpage for the MyCare Ohio Frequently Asked Questions, Conversion Charter, and the current MyCare Ohio conversion program.
For information on home and community-based services, private duty nursing, and additional long-term care services, refer to the resources section at the bottom of the page.
If you have questions or feedback about the Next Generation MyCare program, please contact MyCareConversionQuestions@medicaid.ohio.gov. Medicaid members can find benefits information, including the value-added benefits available for each managed care plan, and enrollment information by visiting the Ohio Medicaid Consumer Hotline website.
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The Next Generation MyCare 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.
All potential applicants were required to notify ODM of their intent to submit a response by June 26 at 4:00 p.m. ET. 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.
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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.
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