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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. Phase 2 includes Sandusky, Erie, Henry, Williams, Defiance, Paulding, Fayette, Fairfield, Licking, and Ashtabula counties. As you prepare for the program, there are a few important things you need to know.
How to become a Next Generation MyCare provider?
If you would like to provide services to Next Generation MyCare members, you must enroll with ODM and contract with the Next Generation MyCare plans. If you 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 deliver services and submit claims but must contract with the Next Generation MyCare plans if you have not already.
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What if I am new to billing in the Next Generation MyCare program?
Billing services in the MyCare program are generally the same as the Next Generation Managed Care program. If you submit claims for Managed Care members today, consider using the same process for MyCare members. If you use a trading partner, contact them before the program starts to check if you need to take any extra steps for your claim to be accepted by ODM.
If you do not have an existing process in place today, consider which of the below options is best for you.
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Providers with a smaller volume of claims typically utilize the Direct Data Entry (DDE) process. DDE is when a provider submits a single claim to the Next Generation MyCare plan through their DDE portal. Learn how to enroll and submit claims via DDE by visiting the plan’s DDE portals:
- Providers with a large volume of claims typically contract with a trading partner to submit claims via the OMES one front door. This supports the provider with billing and reconciliation. View ODM’s Electronic Data Interchange (EDI) Authorized Trading Partners list to see the trading partners currently authorized to work ODM and providers. Providers who want to use a trading partner are encouraged to contact a few to find the one that best fits their needs.
Note: To submit claims for Next Generation MyCare members, you must use the correct plan Receiver ID and payer ID for the program. Additionally, you must use the member’s Medicaid ID even if they have other ID numbers.
Refer to the Companion Guides for more information.
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As part of ODM’s effort to prepare providers for the Next Generation MyCare program, we are hosting a series of webinars. These webinars will share information about the program, what it means for you, and steps you may need to take ahead of the program roll out. ODM encourages providers in Phase 2 counties to join.
Webinars are held on the third Wednesday of each month from March through August, alternating between a session specific to the Ohio Department of Aging (AGE) providers and all other provider types. Register below for the session that best fits your needs and schedule. To learn more, visit the Next Generation MyCare Resources for Providers webpage. Recordings for each session type will be available online after the first session.
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Next Generation MyCare Webinar for the Ohio Department of Aging (AGE) Providers
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Next Generation MyCare Webinar for Providers
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Next Generation MyCare Webinar for the Ohio Department of Aging (AGE) Providers
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Next Generation MyCare Webinar for Providers
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Next Generation MyCare Webinar for the Ohio Department of Aging (AGE) Providers
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Next Generation MyCare Webinar for Providers
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Wednesday August 19, 2026
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ODM is committed to providing access, inclusion, and reasonable accommodation in its services, activities, programs, and employment opportunities in accordance with the Americans with Disabilities Act (ADA), Title VI of the Civil Rights Act, and other applicable laws. Click here for more information.
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ODM is revamping the ways we connect with providers and all our members. Follow us for updates on healthcare coverage, wellness tips, and important information for Ohioans. Stay connected and informed about the latest initiatives and resources available.
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