As part of the Ohio Department of Medicaid’s (ODM) preparation for the Next Generation MyCare program, ODM continues to partner with the Next Generation MyCare plans to improve healthcare for Ohioans and support providers who serve them.  

Buckeye Health Plan won't be an option for new members or for those currently receiving care through another MyCare Ohio plan starting in the 2026 plan year. If a member gets care through Buckeye Health Plan today and wants to keep their plan, no action is required. 

During Medicaid or Medicare open enrollment, members can pick Anthem Blue Cross and Blue Shield, CareSource, or Molina HealthCare of Ohio as their Next Generation MyCare plan.

• Each year Medicaid open enrollment is from November 1 to November 30. You can call the Ohio Medicaid Consumer Hotline at 800-324-8680.

• Each year Medicare open enrollment is from October 15 to December 7. You can call Medicare at 800-633-4227. 

Keep reading to learn more about the Next Generation MyCare program, visit the MyCare Ohio webpage on medicaid.ohio.gov.  

What are the benefits of the Next Generation MyCare program?   

The Next Generation MyCare program has several improvements for providers, including:  

• Streamlined credentialing processes with ODM to become an Ohio Medicaid provider. You still need to contract with each of the Next Generation MyCare plans separately.  
• Better integration with the Next Generation MyCare plans, leading to shorter turnaround times for prior authorizations.  
• New External Medical Review (EMR) process.   
• Enhanced clinical coverage policies for Medicaid primary services, requiring more services to be covered by the Next Generation MyCare plans.  Changes to the services you provide will be dependent on your contract with each Next Generation MyCare plan.  
• Reduced burden for prior authorizations on waiver services in a member’s person-centered care plan (same for private duty nursing).   
• Potential for more waiver providers due to increased network requirements for Next Generation MyCare plans.  
• Additional transportation requirements for the Next Generation MyCare

  plans to support members in getting to their medical visits and services.      

How to become a Next Generation MyCare provider? 

To become a provider in the Next Generation MyCare program you must: 

1. Enroll with ODM by visiting the Medicaid Provider Portal and completing the online application (credentialing, if required, will occur automatically during application processing)
2. Contract with the Next Generation MyCare plans by contacting each of the plans you wish to contract with.
   • Anthem Blue Cross and Blue Shield: 833-727-2170
   • Buckeye Health Plan: 833-998-4892 
   • CareSource: 800-488-0134 
   • Molina HealthCare of Ohio: 855-322-4079

Refer to the Credentialing Guide and Requirements Document for more information. 

Which ID number should be used when submitting a dual benefit claim or a Medicaid-only claim where Medicaid is the primary payer?    

Providers must use the member’s Medicaid ID (MMIS number) when submitting claims through the Ohio Medicaid Enterprise System (OMES) one front door. Medicare ID numbers will not be accepted.   

Read the Next Generation MyCare ID Card One Pager to see the card template.   

How do providers submit claims? 

The process for submitting Electronic Data Interchange (EDI) claims in the Next Generation MyCare program is changing.  

• If you are submitting your claims to the plans portal using direct data entry (DDE) claim, you will submit a single claim to the Next Generation MyCare plan via their existing process. Not all Next Generation MyCare plans accept paper claims. Submit your claims using the plans existing process. 
• If you are submitting an EDI claim for a dual benefit member (a member who gets their Medicaid and Medicare benefits from one Next Generation MyCare plan), you will submit the claim through the one front door, to the Ohio Medicaid Enterprise System (OMES). You must use the member’s Medicaid ID even if they have other ID numbers. The submitted file must use the Next Generation MyCare Plan Receiver ID and the appropriate Payer ID (found within the Companion Guides) in the 2010BB loop for claims to be directed to the correct Next Generation MyCare plan for processing. 
• If you are submitting an EDI claim for a Medicaid-only member, you will submit the claim, also known as a crossover claim, to the primary payer. 
  • If Medicare is the primary payer, submit the claim to Medicare using your normal process.  Claims for Ohio MyCare members will be automatically crossed-over to the Next Generation MyCare plan.  
  • If the primary payer is a Medicare Advantage/Part C plan, submit the claim to that payer using your normal process. Once the primary payer has adjudicated the claim and returned the Remittance Advice, submit the claim through the OMES one front door using the Receiver ID and Payer ID as described for a dual benefit claim.  

Refer to the Companion Guides for more information. 

What if providers need to submit a claim for a member who was enrolled in a plan that will not be a part of the Next Generation MyCare program? 

Aetna Better Health of Ohio and United Healthcare Community Plan will no longer be MyCare plans as of December 31, 2025. Aetna and United will continue to pay claims for up to 365 days from the end of the year and are responsible for any claims that have dates of service through December 31, 2025. Any claims should be submitted to Aetna or United using existing processes. 

As a pharmacy provider, are there changes for me? 

In the Next Generation MyCare program, you will work with the Next Generation MyCare plan’s Pharmacy Benefit Manager to administer pharmacy benefits for MyCare members. Refer to the MyCare Ohio Pharmacy Billing Reference Guide for more information. 

Where can I learn more about the Next Generation MyCare program? 

• The MyCare Ohio webpage on Medicaid.ohio.gov shares information about the Next Generation program and houses all resources.
• The Next Generation MyCare Provider Help Desk One-Pager shares contact information by topic in one place, so you know who to contact when you have questions or need help. 
• The Next Generation MyCare Provider Frequently Asked Questions (FAQ) answers your most common questions about the current and Next Generation MyCare program. 
• The Next Generation MyCare Member ID Card One Pager provides an overview of the card template. All MyCare Ohio members will receive a new Next Generation member identification (ID) card that will be used at their appointments. The Next Generation member ID cards include important information about a member’s plan, doctors, and who to contact for help all in one place. Providers must use the member’s Medicaid ID (MMIS number) when submitting claims through the Ohio Medicaid Enterprise System (OMES) one front door.