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About Provider Network Management and Centralized Credentialing

Provider Network Management (PNM)

What is PNM?

Ohio Department of Medicaid (ODM) is in the process of modernizing its management information systems. This modernization roadmap, developed in accordance with the Centers for Medicare and Medicaid Services (CMS) guidance, includes a transition to a modular system called the Ohio Medicaid Enterprise System (OMES) that will support ODM in meeting several modernization goals.

As a part of this roadmap, new, updated functionality is being built into OMES rather than MITS. The PNM is a modular component of OMES, which has replaced the current MITS provider enrollment subsystem and provider portal

What benefits are included with PNM?

There are several new features and enhancements in the PNM module that are designed to streamline processes and reduce administrative burdens for providers. The module allows providers to:

  • View specialties and effective dates.
  • Review and accept submitted provider change or update requests.
    • There is no need for emails or letters – this includes change of operator notices, name changes, adding specialties, etc.
  • Access a comprehensive provider directory at the state level.
  • Opt in or out of text message notifications.
  • View all long-term care agreements online.
    • No more paper agreements – agreements are available online and do not require mailing back and forth for signatures.

Centralized Credentialing

What is Centralized Credentialing and what benefits does it provide?

ODM implemented a single, centralized provider credentialing process at the state level with the go-live of the PNM portal. There are many benefits of this centralized approach, including:

  • Providers subject to credentialing will only undergo one credentialing and recredentialing process at the state level vs. a separate additional process for each Ohio Medicaid managed care organization (MCO).
  • A credentialing verification organization (CVO) – Maximus, Inc. – maintains the National Committee for Quality Assurance (NCQA) accreditation requirements for Ohio’s MCOs. Maximus, Inc. also serves as ODM’s single point of contact for providers as they undergo credentialing and recredentialing reviews.
  • Delegate agreements with hospital systems and a delegate review process, ODM can deem credentialing work already completed by these providers and reduce or eliminate the need for providers to engage in multiple credentialing processes.

Centralized Credentialing Infographic

Centralized Credentialing Summary