To provide services in the program, you must enroll with ODM if you have not already so and contract with the Next Generation MyCare plans. You can enroll with ODM by visiting the Medicaid Provider Portal and completing the online application. To contract with the plans, you must also contact each of the plans you wish to contract with. Refer to the Credentialing Guide and Requirements Document for more information.

The process for submitting Electronic Data Interchange (EDI) claims in the Next Generation MyCare program is changing. Refer to the Companion Guides for more information. 

• If you are submitting your claims to the plan’s portal using Direct Data Entry (DDE), you will submit a single claim to the plan via their existing process. 
• If you are submitting an EDI claim for a dual benefit member or for a Medicaid-only member where Medicaid is the primary payer, 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, the Next Generation MyCare Plan Receiver ID and the appropriate Payer ID for claims to be directed to the correct plan for processing.  
• If you are submitting an EDI claim for a Medicare covered service for a Medicaid-only member, you will submit the claim to the primary payer. If Medicare is the primary payer, submit the claim to Medicare using your normal process. 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.  

The plans will begin providing healthcare benefits to members. Members who live in a MyCare Ohio county will start getting their care through a Next Generation MyCare plan on January 1, 2026. With this change, members will also have a new member ID card to use at their appointments with you. Check out the Next Generation MyCare Member ID Card One-Pager to learn more.   

If a member has questions about their plan or benefits, they should contact the Ohio Medicaid Consumer Hotline at 800-324-8680 Monday through Friday 7 a.m. – 8 a.m. and Saturdays 8 a.m. – 5 p.m. Eastern time or visit www.ohiomh.com.