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Get ready – on April 1 the Ohio Department of Medicaid (ODM) is expanding its roll out of the Next Generation MyCare program. The next phase includes Sandusky, Erie, Henry, Williams, Defiance, Paulding, Fayette, Fairfield, Licking, and Ashtabula counties. Please help us spread the word and stay informed by visiting Next Generation MyCare Stakeholders & Partners webpage.
ODM encourages Area Agencies on Aging (AAA) to educate members and providers ahead of the program becoming available. Your outreach supports us to increase the number of in-network providers available for members, enables members to get access to care quickly, and supports providers to submit claims.
What is changing for members and how can you support them?
Once the program becomes available in an eligible member’s county, they will receive a letter from ODM or their plan with information about their plan, when it begins, and options for changing plans or coordinating Medicare and Medicaid coverage.
As you interact with members, we encourage you to share the Member Impacts One-Pager, Next Generation MyCare Member Frequently Asked Questions (FAQ) and Next Generation MyCare Member Help Desk One-Pager to help inform them about the program and guide them through the key steps they need to complete before it launches in their county.
What is changing for providers and how can you support them?
Providers who would like to deliver services to Next Generation MyCare members must enroll with ODM and contract with the Next Generation MyCare plans. If they are already enrolled as an ODM provider and contracted with plans, no additional action is required. Ohio Department of Aging (AGE) enrolled providers can continue to provide services and submit claims but must contract with the Next Generation MyCare plans if they have not already.
Additionally, claims for Next Generation MyCare members can be submitted to the plan portal using Direct Data Entry (DDE) or through the Ohio Medicaid Enterprise System (OMES) one front door.
For providers who are new to billing in the Next Generation program:
- Billing services in the Next Generation MyCare program is generally the same process as the Next Generation Managed Care program. If a provider submits claims for Managed Care members today, consider using the same process for MyCare members.
- If a provider does not have an existing process in place today, they should consider which option is best for them by viewing the Next Generation MyCare Resources for Providers webpage.
As providers have questions, direct them to the Provider Help Desk One-Pager to know where to go for help. Be on the lookout for additional resources about the provider claims submission process coming soon!
Thank you for supporting ODM as we implement the Next Generation MyCare program in the rest of Ohio.
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