The Ohio Department of Medicaid (ODM) is issuing a reminder to help make sure provider calls related to the Next Generation MyCare program are routed accurately and handled as efficiently as possible. Proper use of the phone menu options helps reduce call transfers and makes sure providers reach the appropriate Next Generation MyCare plans without delay.

Direct Next Generation MyCare Inquiries to the Correct Plans

Providers with questions regarding eligibility, claims, prior authorization, payments, replacement member ID cards, or any other Next Generation MyCare program matters should contact their plan directly.

When calling the main phone line, providers should:

1. Select Option 9 for all Next Generation MyCare–related inquiries.
   • Option 1 should not be used, as it is designated solely for Fee‑for‑Service (FFS) inquiries.
2. After selecting Option 9, callers will be directed to the plan menu, where they may:
   • Select Option 1 for Provider
   • Select Option 2 for Next Generation MyCare Provider
   • Then choose the option for the appropriate Next Generation MyCare plan

Using the correct Interactive Voice Response (IVR) options ensures calls are routed accurately, reduces unnecessary transfers, and speeds up resolution of provider questions.

ODM appreciates the continued partnership and attention to this important reminder.

A message to our Ohio Medicaid Providers, Provider Administrators, Power Agents, or Agents

ODM is committed to safeguarding provider data. To support that commitment, ODM has updated the Provider System Administrator Change Request process and introduced new requirements and recommended best practices to ensure strong data integrity and confidentiality.

Updated PNM Administrator Change Request Form

Effective January 1, ODM released an updated PNM System Administrator Change Request Form (ODM 10304). The revised form adds a new requirement and includes a full ODM review for administrator changes within facility, group, or organizational provider types. 

Option 1 – Organizational Administrator Change (Non–Self-Service)

Use Option 1 ONLY when the PNM self-service option is unavailable and the organization needs to change the PNM Administrator.

This option requires:

• A completed ODM 10304 form, and
• A letter on organizational letterhead, signed by an authorized senior leader, stating: “The PNM Administrator Change Request has been reviewed and approved by the appropriate staff within the organization.”

Submit both documents to the ODM Integrated Help Desk (IHD) at IHD@medicaid.ohio.gov. Requests submitted under Option 1 require full ODM review and additional processing time. Providers are encouraged to use the PNM self-service option whenever possible for immediate updates.

Option 2 – Individual Providers

Option 2 applies to individual providers who need to assign someone else to serve as the PNM Administrator when the self-service function is not available. These requests are subject to standard reviews, and most are processed quickly.

Recommended Security and Compliance Practices

To support secure and consistent system administration, ODM recommends that providers:

• Establish clear governance structures defining roles, responsibilities, and decision-making authority.
• Maintain written policies and procedures for compliance and oversight.
• Document approval workflows to support accountability and transparency.
• Develop contingency plans to ensure continuity during administrative changes.

By adopting these practices, ODM aims to promote secure, consistent, and accountable management of PNM administrator roles.

Questions? Contact the ODM IHD at IHD@medicaid.ohio.gov .

Thank you for your continued partnership in supporting Ohio Medicaid.