Learn more about the next generation of Ohio Medicaid managed care and what it means for providers
IMPORTANT UPDATE: Ohio Medicaid is upgrading its provider enrollment system
Effective August 1, 2022, ODM will not be accepting new provider enrollment applications or continue any in-progress enrollment applications through the MITS Provider Enrollment System. Details on the process for enrollment of new OhioRISE providers from August 1 to October 2022 will be communicated prior to August 1st.
Effective October 1, 2022, all provider enrollment applications must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) portal. After its implementation, the PNM portal will be the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service.
About Ohio Medicaid’s Next Generation Program
In 2019, the Ohio Department of Medicaid (ODM) launched a series of procurements and strategic initiatives with the goal of creating a Next Generation managed care program focused on the individual. This focus supports us in doing better for the people we serve and the providers who are our partners.
The Next Generation of Ohio Medicaid program will be implemented in stages to avoid unnecessary disruption and confusion for members and to reduce burdens on our service providers. The Next Generation program will be implemented in the following stages:
Stage 1: On July 1, 2022, OhioRISE will begin providing specialized services, which will help children and youth with behavioral health needs and help coordinate care for those who receive care across multiple systems.
Stage 2: On October 1, 2022, Centralized Provider Credentialing will begin which will reduce administrative burden on providers. Also, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members.
Stage 3: On December 1, 2022, the implementation of the Next Generation managed care plans will occur. Members will experience benefits that help address their individual health care needs such as increased access to care coordination and care management supports. Also in stage three, ODM will implement additional improvements to streamline the process of claims and prior authorization submission for providers.
To learn more about the Next Generation of Ohio Medicaid and the staggered implementation, check out the Ohio Medicaid Providers Factsheet.
Join Us for the Next Generation Ohio Medicaid Program Provider Overview Webinar
We are excited to share that the Ohio Department of Medicaid (ODM) is kicking off its provider awareness and training efforts in preparation for the October 1, 2022, Stage 2 launch of the Next Generation program! To begin these efforts, we will be hosting a 2-hour webinar to share information on the exciting changes Ohio Medicaid providers can expect, including an overview on the transition to the Ohio Medicaid Enterprise System (OMES) modules, upcoming training plans and dates, and where providers can receive communications from ODM throughout the Next Generation transition and implementation.
Want to learn more about the benefits Ohio Medicaid members and providers will experience through the Next Generation program Stage 2 launch? Check out the PNM & Centralized Credentialing and Single Pharmacy Benefit Manager (SPBM) pages of this website.
For questions, please contact ODMNextGen@medicaid.ohio.gov.
ODM is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws. To request a reasonable accommodation due to a disability, please contact ODM’s ADA coordinator at 614-995-9981/TTY 711, Fax 1-614-644-1434, or email: ODM_EEO_EmployeeRelations@medicaid.ohio.gov at least three (3) business days prior to the scheduled meeting. Further information can be found here: Notice of Nondiscrimination.
Registration is open for Provider Network Management (PNM) Training!
Training and Learning Management System
In preparation for Stage 2 go-live (Oct. 1, 2022), we are offering a variety of training options including self-paced, virtual, and in-person training options. Absorb, the Learning Management System (LMS), is where you will access the self-paced training and sign up for the virtual and/or in-person sessions.
Training sessions are scheduled to begin Aug. 1, 2022, and it is important that you create an account in the LMS to ensure you have access to all training sessions, answer forms, and PNM resources in advance. Visit the Job Aid to access the LMS and follow the steps to create your account and register for training.
Contracting with ODM’s Current Managed Care Organizations
Until ODM goes live with Centralized Credentialing on October 1, 2022, managed care organizations (MCOs) will continue to credential providers. Please contact each MCO for current information about provider credentialing.