Important

Through a series of PNM queries, Ohio Department of Medicaid (ODM) has identified several affiliation issues that impact billing organizations claims.  It is imperative that providers fully execute all steps when affiliating a rendering provider to their group/organization/hospital to avoid claims payment issues. ODM has identified that providers tend to leave affiliations in one of two incomplete statuses (Affiliation Status): 

• Pending Approval  
• Confirmed  

A provider affiliation can be initiated and completed by the group/organization/hospital, or it can be initiated through the rendering practitioner. If the affiliation is initiated through the rendering individual, it is not complete and remains in a “Pending Approval” status until the group/organization/hospital accepts and saves the affiliation. At that point it will appear as “Confirmed”. For the provider affiliation to be sent downstream and receive an “Active” status, there are two remaining critical steps:  

1. Click <Save> at the top of the page, which saves all the updates. Once saved, the user will have a new <Submit for Review> button appear.   

2. Click <Submit for Review>. Users must click on this button to complete the process and submit the affiliations downstream. Affiliations are fully executed ONLY once this final step has been taken.   

Important: If these steps are not completed, the provider affiliation is not sent downstream, and providers will experience claims payment issues.   

Update on the Next Generation Program

On February 1, 2023, Ohio Medicaid implemented the Next Generation managed care plans. These changes provide Ohio Medicaid managed care members enhanced healthcare services that best fit their individual healthcare needs and streamline claims and prior authorizations for providers. For information on OhioRISE, please see the updated OhioRISE Provider Enrollment and Billing Guidance. Please note, these changes do not apply to MyCare. MyCare providers should continue to submit claims and prior authorizations directly to the appropriate payer, either the MyCare managed care plan or Medicare.

Also launched on February 1 as part of the Next Generation program are the Electronic Data Interchange (EDI) and the Fiscal Intermediary (FI). The EDI is the new exchange point for trading partners on all claims-related activities, providing transparency and visibility regarding care and services. The FI facilitates the processing of claims via the EDI. Providers, trading partners, and managed care entities will not directly interact with the FI. Providers who direct data entry (DDE) managed care claims and prior authorizations do so through each managed care entity’s portals or their respective electronic processes. 

Additional information and links to resources about these can be found in our February 1 Launch Ohio Medicaid Provider One-Pager, and February 1 Launch Ohio Medicaid Provider Helpdesk One-Pager.

About the PNM module

Ohio Department of Medicaid (ODM) is excited to announce that the Provider Network Management (PNM) module went live on October 1! The PNM module serves as the single-entry point for secure portal functions such as claims submissions, prior authorizations, and member eligibility verification. Since October 1, providers are redirected from the PNM module to the appropriate MITS functionality.

What actions do I need to take?

1. An OH|ID is required for providers to access the PNM module. If you do not have an existing OH|ID, you will need to create one to access the PNM module.
   • Access the PNM module by clicking here.
   • Click on the “Don't Have an Account Click Here” link on the PNM homepage. You will be redirected to the OH|ID site to create your new account.
   • If you need assistance or experience technical issues, contact the ODM Integrated Help Desk at 800-686-1516 or IHD@medicaid.ohio.gov.
2. If you have an OH|ID or once you have created one, use your new OH|ID to log in to the PNM module by clicking here.
3. Setup your Administrator & Agent roles in the PNM module. Remember, these will need to be reestablished in the PNM module. For more information, access the Agent Assignment & Actions Quick Reference Guide.

You are now able to access the features and functionality available in the PNM module. If you need technical assistance or encounter an error accessing the PNM, please contact the ODM Integrated Help Desk Command Center at 800-686-1516. If you have questions about OH|ID, please visit the OH|ID Help Center.

Getting help with module issues and questions

If you are having trouble with the PNM module, here are some helpful resources that you can use to resolve the most common issues providers are experiencing:

• Identifying your role within PNM – Click this link for information on how to determine what role you are currently assigned to in the PNM module.
• Agent Assignment & Actions – Click this link for information on how an Administrator can assign agent roles.
• Finding Your OH|ID - Click this link for information on how to locate your OH|ID user ID number.
• Enabling SMS Recovery for OH|ID – Click this link for information on how to enable SMS recovery for your OH|ID username or password.
• Assigning Medicaid IDs to administer PNM module accounts – Call the Ohio Medicaid Integrated Help Desk at 1-800-686-1516 and select option 2, and then select option 3 to speak to a live agent. Call representatives will confirm provider credentials prior to updating the system. A call-back option is available. Additional information about this change can be found further down on this webpage.
• PNM Affiliations QRG – Click this link for step-by-step instructions and information on affiliations within the PNM module. 

1099 IRS forms now available

1099 IRS forms are now available within the Provider Network Management (PNM) module. Visit the Accessing the 1099 Information quick reference guide to learn more about accessing 1099 forms.

Our next steps for resolving PNM module issues and reducing help desk hold times

We are working with our Maximus vendor to add additional help desk representatives as soon as possible to reduce wait times. We are adding additional staff to help answer your questions about establishing login credentials, navigating the PNM module landing page, affiliating providers with a role in the PNM module, and general PNM module-related questions. In addition, we are adding staff to support more complex provider questions, including re-connecting providers to the correct role if an incorrect role was previously selected, and advanced PNM module functionality questions.

The “Select Provider” button on the Provider Network Management (PNM) module has been disabled

Maximus has disabled the “Select Provider” button on the PNM. When available, this button allows provider administrators to obtain assignment of a Medicaid ID for their provider account.

We became aware of a potential security issue and are providing full support to Maximus as they work to correct the issue.

While this is being corrected, to assign Medicaid IDs to Administrator accounts in the PNM module, providers will need to call the Ohio Medicaid Integrated Help Desk at 1-800-686-1516 and select option 2, and then select option 3 to speak to a live agent. Call representatives will confirm provider credentials prior to updating the system. Representatives are available Monday-Friday 8 a.m. – 4:30 p.m.