|
On January 1, the Ohio Department of Medicaid (ODM) implemented the Next Generation MyCare program in 29 counties to provide enhanced healthcare benefits to Ohioans who have both Medicaid and Medicare. Continue to help us spread the word about the Next Generation MyCare program as you work with members and providers, including:
- What the program means for members and when the program will be available to them.
- Steps providers need to take to serve members.
- How providers submit claims.
What does this mean for members?
Eligible individuals living in one of the 29 counties now get care through a Next Generation MyCare plan. Members who were in the Ohio Home Care, Assisted Living, or PASSPORT waiver when they were enrolled in the program are now enrolled in the MyCare Ohio Waiver.
Starting on April 1, ODM is rolling out the program in the rest of Ohio. Once the program is available in an eligible individual’s county, they will get a letter from ODM that gives them information about their plan, when it begins, and options for changing their plan or coordinating their Medicare and Medicaid coverage.
If members have questions related to eligibility, enrollment, benefits, plan selection, or finding a doctor, they can contact the Ohio Medicaid Consumer Hotline at 800-324-8680 or visit https://ohiomh.com/. Representatives are available Monday through Friday 7 a.m. – 8 p.m. and Saturdays 8 a.m. – 5 p.m. Eastern Time (ET).
What does this mean for providers?
Providers who are new to the program and want to serve members must first enroll with ODM and contract with each Next Generation MyCare plan they intend to join as an in-network provider. Providers who are enrolled with the Ohio Department of Aging (AGE) can continue to provide services to members and submit claims in the program. However, they should contract with the Next Generation MyCare plans if they have not already.
Once they begin serving members, providers will submit Medicaid primary payer Electronic Data Interchange (EDI) claims through the Ohio Medicaid Enterprise System (OMES) one front door or to the plan’s portal using their existing process for Direct Data Entry (DDE). For EDI claims where Medicare is the primary payer, they will submit those crossover claims to the primary payer.
If providers have questions related to OMES submitted claims, prior authorizations, member eligibility, provider contracting, waiver support, or general Medicaid billing they can contact 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. ET.
Where can I learn more about the program?
Return to Top
|
