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

• If you are submitting your claims to the Next Generation MyCare 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.

Ensuring members receive care is the ODM’s priority. When you provide services to Next Generation MyCare members and are confirming eligibility, the following methods can be used to support verification:  

1. Check the Member ID Card. If the ID card has a Next Generation MyCare program logo it is indicative that the member is a Next Generation MyCare member. 
2. Check member eligibility via Provider Network Management (PNM) or the Electronic Data Interchange (EDI) 270/271 process. 
3. Call the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov. Representatives are available Monday through Friday, 8 a.m. – 4:30 p.m. Eastern Time.