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Resources for Community Partners and Providers

On this page, community partners and providers can learn more about the actions they should take now to support the successful implementation of OhioRISE. Ohio Department of Medicaid (ODM) holds office hours for community partners and providers to raise questions to OhioRISE subject matter experts to help ongoing implementation and operationalization of the program. Click on the "OhioRISE Office Hours" tab below to learn more.

1. OhioRISE Office Hours 

The below OhioRISE office hours provide opportunities for you to raise additional questions to OhioRISE subject matter experts to help ongoing implementation and operationalization of the program.

OhioRISE Implementation Office Hours

Meeting Date and Time Meeting Link
Every Tuesday from 2-2:30 p.m. through 2022 Click here to join

Family and Children First Council (FCFC) OhioRISE Office Hours 

Meeting Date and Time Meeting Link
Every second Wednesday from 4-5 p.m. starting July 20 through 2022 Click here to join

Public Children Services Association (PCSA) OhioRISE Office Hours 

Meeting Date and Time Meeting Link
Every Friday from 11 a.m.-12 p.m. through  2022  Click here to join

Developmental Disability System OhioRISE Office Hours 

Meeting Date and Time Meeting Link
Every second Thursday from 3-4 p.m. starting September 29 through 2022  Click here to join

2. OhioRISE Provider Enrollment Guidance 

OhioRISE Provider Enrollment and Billing Guidance Effective October 1

All provider enrollment applications are now submitted using Ohio Medicaid’s new PNM module. The PNM module is the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service. For resources and more information about the PNM module, visit the PNM & Centralized Credentialing page

ODM has updated its guidance to help OhioRISE providers understand provider enrollment and specialty addition changes that went into effect October 1. Please view the updated OhioRISE Provider Enrollment and Billing Guidance document to learn more. Other notable changes to the guidance document include clarification around Mobile Response and Stabilization Service (MRSS) billing.

Provider Enrollment and Specialty Addition Guidance for OhioRISE BH Respite Services 

Behavioral Health (BH) Respite provides a short-term temporary relief to the primary caregiver or caregivers of an OhioRISE plan enrolled youth. This service can be provided inside or outside of the individual’s residence and is designed to support and preserve the primary caregiving relationship. The Ohio Medicaid rule governing this service is OAC 5160-59-03.4.

3. Claims Submission Guidance 

Updated OhioRISE Practitioner Modifiers

ODM and Aetna Better Health of Ohio have agreed to align OhioRISE practitioner modifier requirements for outpatient and professional claims with those used in ODM’s fee-for-service program. In accordance with this set of changes, the OhioRISE Provider Enrollment and Billing Guidance and the OhioRISE Care Management Entity (CME) Manual were updated on June 21. Both documents now describe Aetna’s practitioner modifier requirements for community behavioral health services as aligning with those in ODM’s fee-for-service program.

With the implementation of this update in Aetna’s billing requirements, Aetna will NOT REQUIRE practitioner modifiers on the following types of claims, unless the rendering practitioner holds multiple licenses or credentials with differing scope of practice.

  • Community mental health agency claims (provider type 84).
  • Community substance use disorder treatment provider claims (provider type 95).
  • OhioRISE CME claims.
  • Other professional and behavioral health services reimbursed in accordance with Appendix DD of Ohio Administrative Code (OAC) rule 5160-1-60 (this includes BH services rendered by providers other than community MH/SUD agencies).
  • Outpatient hospital claims submitted for Enhanced Ambulatory Patient Groups (EAPG) reimbursement.

In alignment with ODM fee-for-service policy, Aetna will require practitioner modifiers on outpatient hospital claims submitted for Outpatient Hospital Behavioral Health (OPHBH) reimbursement. Aetna’s OPHBH practitioner modifier requirements will mirror ODM’s fee-for-service requirements.

Practitioners with multiple licenses or credentials

Aetna will require rendering practitioners holding multiple licenses or credentials with differing scopes of practice to use ODM’s requirements for enrollment and claims submission, including:

  • Provider enrollment with a multi-license specialty.
  • Rendering provider reporting their additional licensure/credentials on claims.
  • Use of modifiers identified on ODM’s dual licensure grid, which can be found on https://bh.medicaid.ohio.gov/manuals

Aetna will be reconfiguring its claims engine to incorporate the requirements outlined above. Until this reconfiguration is complete, Aetna will need to process some claims manually. Providers will not be required to resubmit or adjust claims at a later date if their claims are processed manually because of Aetna’s reconfiguration timeline.

Other changes were made to the OhioRISE Provider Enrollment and Billing Guidance and the OhioRISE Care Management Entity Manual on June 14, 2022, including some clarifying language and corrections made based on stakeholder feedback. Those changes are noted in the version logs at the beginning of each document.

The Medicaid Behavioral Health Provider Manual was also updated on June 14, 2022, to clarify that CANS assessments must be entered in Ohio’s CANS IT system only to establish and maintain OhioRISE eligibility.

OhioRISE Mixed Services Protocol 

The OhioRISE Mixed Services Protocol clarifies financial responsibility for behavioral health services provided to youth who are enrolled in the OhioRISE plan. The protocol only includes those services that are covered by both the OhioRISE plan and the MCO and excludes the enhanced or new services that are only covered by the OhioRISE plan. Financial responsibility for behavioral health services provided to youth who are not enrolled in the OhioRISE plan remain the responsibility of the recipient’s managed care organization or fee‐for‐service Medicaid.

Providers can use the OhioRISE Mixed Services Protocol to identify the entity to which claims should be submitted if a youth is enrolled in the OhioRISE plan. Within this ducment, services are defined in the column on the left, while the entity to which the claim should be routed, dependent on the date of service, is in the righthand column.

4. OhioRISE Ohio Administrative Code (OAC) Rules

As part of the final step in the rule filing process, the full package of proposed OhioRISE Ohio Administrative Code (OAC) rules were reviewed by the Joint Committee on Agency Rule Review (JCARR) and final filed on June 21 and become effective on July 1. 

Since January 2021, we have held 50+ Advisory Council and Workgroup meetings in which stakeholders helped us develop the new and enhanced services and other important elements of the program that are reflected in the OhioRISE OAC Rules. With the invaluable feedback that our stakeholders provided to us during public meetings, written pre-clearance comments, written clearance comments, and throughout the rule filing process, we carefully reviewed and made changes to the rules to build a program that will effectively support providers and help Ohio’s children/youth with complex behavioral health needs and their families.  

You can visit the Register of Ohio website at https://www.registerofohio.state.oh.us/rules/search or click on the below links to view the final filed OhioRISE rules: 

Relevant Documents

Summary of Changes

Clearance Comments

OAC Rule Webpage

OhioRISE Care Coordinator Years of Experience Guidance and Application for Partially Meeting Years of Experience

5. OhioRISE Encounter Data Quality Measures

6. Provider Contracting Information

Contracting with the OhioRISE Plan

We encourage all providers interested in contracting with Aetna to provide behavioral health services to children and youth enrolled in the OhioRISE program to contact Aetna Better Health of Ohio. You can contact Aetna via the provider relations contact information listed below.

OhioRISE Provider Relations Contact Information
MCO   Phone Number Web Address Email

 

Aetna Better Health of Ohio, Inc

 

1-855-364-0974

https://www.aetnabetterhealth.com/ohio/providers/join

OHRISE-Network@aetna.com

Contracting with ODM's Current MCOs

Providers interested in contracting with Ohio Medicaid’s current MCOs can contact them via the provider relations contact information listed in the table below.

Ohio Medicaid MCO Provider Relations Contact Information
MCO   Phone Number Web Address

Buckeye Community Health Plan​

1-866-246-4358 ​

https://www.buckeyehealthplan.com/providers/become-a-provider/join-our-network.html

CareSource Ohio, Inc.​

1-800-488-0134​

https://www.caresource.com/oh/providers/education/become-caresource-provider/medicaid/

Molina Healthcare of Ohio, Inc.  ​

1-855-322-4079​

https://www.molinahealthcare.com/providers/oh/medicaid/home.aspx

Anthem Blue Cross Blue Shield* (Operated by Paramount Advantage) 1-800-891-2542 https://www.paramounthealthcare.com/services/providers/join-our-network/

UnitedHealthcare Community Plan of Ohio

 ​800-600-9007​

https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html

*Administered by Paramount Advantage in West and Northeast Region until February 1, 2023. 

As of October 1, ODM has implemented centralized provider credentialing, meaning providers no longer need to seek credentialing individually through each MCO. To learn more, visit the PNM & Centralized Credentialing page.

Contracting with ODM's Next Generation MCOs

Providers interested in contracting with Ohio Medicaid’s next generation MCOs can contact them via the Provider Relations contact information listed in the table below.

Next Generation MCO Provider Relations Contact Information
MCO   Phone Number Web Address Email

AmeriHealth Caritas Ohio, Inc.

1-833-296-2259​ 

https://www.amerihealthcaritasoh.com/provider/index.aspx 

ProviderRecruitmentOH@amerihealthcaritas.com 

Anthem Blue Cross and Blue Shield*

1-800-462-3589

https://www.anthem.com/provider/getting-started/  ​

OHMedicaidProviderQuestions@Anthem.com   

CareSource Ohio, Inc.​

1-800-488-0134​

https://www.caresource.com/oh/providers/education/become-caresource-provider/medicaid/

Ohio_Provider_Contracting@caresource.com   

Humana Healthy Horizons in Ohio

1-877-856-5707

https://www.humana.com/provider/medical-resources/ohio-medicaid

OHMedicaidProviderRelations@humana.com

Molina Healthcare of Ohio, Inc.  ​

1-855-322-4079​

https://www.molinahealthcare.com/providers/oh/medicaid/home.aspx

OHContractRequests@MolinaHealthCare.com   

UnitedHealthcare Community Plan of Ohio, Inc.

 ​800-600-9007​

https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html

N/A

Buckeye Community Health Plan​

1-866-246-4358 ​

https://www.buckeyehealthplan.com/providers/become-a-provider/join-our-network.html

OHNegotiators@CENTENE.COM

*Administered by Paramount Advantage in West and Northeast Region until February 1, 2023. 

As of October 1, ODM has implemented centralized provider credentialing, meaning providers no longer need to seek credentialing individually through each MCO. To learn more, visit the PNM & Centralized Credentialing page.

Contracting with the SPBM vendor, Gainwell Technologies 

Pharmacies must be enrolled with ODM to contract with the SPBM vendor, Gainwell Technologies. Pharmacies can enroll at any time if they are not already enrolled.

All pharmacy will then need to contract with Gainwell. All pharmacies will have to contract with Gainwell to provide pharmacy services for Medicaid managed care members. For pharmacy contracting questions, Gainwell may be reached by email at OH_MCD_PBM_network@gainwelltechnologies.com or by phone at (833-) 491-0364.

7. Opportunities for Collaboration Between BH Providers and OhioRISE Care Coordinators

The care coordinators working within the OhioRISE program are responsible for reaching out to new OhioRISE enrollees and their caregivers, speaking to the youth and their caregivers about their Child and Family Team, and assisting the Child and Family Team in team meetings, information dissemination, and outcome tracking.  

Ohio Medicaid’s enrolled health care providers are also permitted to collaborate with OhioRISE care coordinators from CMEs and Aetna. This partnership is beneficial to our Medicaid members because it utilizes the expertise of health care providers while offering additional perspective from the OhioRISE care coordinators. Opportunities for collaboration include assisting the initial OhioRISE care coordination engagement for new OhioRISE members and joining an OhioRISE Child and Family Team.  

For more information on the opportunities for collaboration, please view the Opportunities for Collaboration between Behavioral Health Providers and OhioRISE Care Coordinators guide. 

8. OhioRISE Flyers and Brochures for Youth and Families

OhioRISE Brochure for Youth and Families 

We encourage OhioRISE’s community partners to distribute the OhioRISE brochure to youth and their families. The brochure provides high-level information regarding OhioRISE to help youth and their families understand the program and its major components. Youth and their families will find information about eligibility, covered services, CANS assessments, how to get more information on OhioRISE, contact information for questions, and more. This brochure is also available as a flyer.

The OhioRISE brochure is available in the following languages:

Follow these instructions to print the OhioRISE brochure:

  1. Open this document and click “print.”
  2. Select “color” if you prefer to print in color. 
  3. Select “print on both sides: flip on short edge.” If your printer does not have the capability to print on both sides, please print the first page on one side, then flip the paper and feed it through the printer to print the second page.
  4. Once printed, fold the brochure in a trifold with the “when can a youth start receiving OhioRISE services?” page on the back of the brochure.

OhioRISE CANS Assessment Flyer for Youth and Families 

OhioRISE CANS assessment flyer for young people and families: explains OhioRISE, CANS assessments, and the role of CANS assessments in determining OhioRISE eligibility. This flyer can be distributed by CANS assessors prior to or at the time of a CANS assessment. 

Follow these instructions to print the OhioRISE CANS assessment flyers:

  1. Open the document and click “print.”
  2. Select “color” if you prefer to print in color. 
  3. Select “print on both sides: flip on long edge.” If your printer does not have the capability to print on both sides, please print the first page on one side, then flip the paper and feed it through the printer to print the second page.

OhioRISE Overview Flyer for Children, Youth, and Caregivers Receiving MRSS

OhioRISE overview flyer for children, youth, and caregivers receiving MRSS 

Follow these instructions to print the OhioRISE MRSS flyers:

  1. Open the document and click “print.”
  2. Select “color” if you prefer to print in color. 
  3. Select “print on both sides: flip on long edge.” If your printer does not have the capability to print on both sides, please print the first page on one side, then flip the paper and feed it through the printer to print the second page.

OhioRISE 1915(c) Waiver Overview Flyer for Children, Youth, and Caregivers

As part of OhioRISE, the Ohio Department of Medicaid (ODM) created a new 1915(c) Home and Community Based Services (HCBS) Medicaid waiver to offer additional services for qualifying children and youth who have some of the greatest needs within the program. These services include Out-of-Home Respite, Transitional Services and Supports, and Secondary Flex Funds. 

Please view and share the OhioRISE Waiver Overview for Children, Youth, and Caregivers

9. OhioRISE Flyers and Brochures for Community Partners

OhioRISE Flyer for Community Partners

The OhioRISE flyer provides comprehensive information on OhioRISE so that community partners can have the knowledge necessary to talk to youth and their families regarding the program. The OhioRISE flyer provides supplemental information that is more in-depth than the OhioRISE brochure, including information about the basics of OhioRISE, eligibility, covered services, enrollment, and scheduling a CANS assessment. 

Follow these instructions to print the OhioRISE flyer:

  1. Open this document and click “print.”
  2. Select “color” if you prefer to print in color. 
  3. Select “print on both sides: flip on long edge.” If your printer does not have the capability to print on both sides, please print the first page on one side, then flip the paper and feed it through the printer to print the second page.

OhioRISE CANS Assessment Flyer for CANS Assessors

OhioRISE CANS assessment flyer for CANS assessors: provides information to CANS assessors so they have an understanding of OhioRISE and CANS assessment implications for OhioRISE enrollment. This flyer is for all CANS assessors across settings. 

Follow these instructions to print the OhioRISE CANS assessment flyers:

  1. Open the document and click “print.”
  2. Select “color” if you prefer to print in color. 
  3. Select “print on both sides: flip on long edge.” If your printer does not have the capability to print on both sides, please print the first page on one side, then flip the paper and feed it through the printer to print the second page.

OhioRISE Overview Flyer for MRSS Providers

OhioRISE overview flyer for Mobile Response and Stabilization Services (MRSS) providers

Follow these instructions to print the OhioRISE MRSS flyers:

  1. Open the document and click “print.”
  2. Select “color” if you prefer to print in color. 
  3. Select “print on both sides: flip on long edge.” If your printer does not have the capability to print on both sides, please print the first page on one side, then flip the paper and feed it through the printer to print the second page.

10. Contacts for Support

CANS training: Please contact the COE at hxd256@case.edu. 
Medicaid provider enrollment: Please contact the ODM Integrated Help Desk at 1-800-686-1516 and select the apprioriate option for support. 
OhioRISE program: Please contact the OhioRISE mailbox and visit the OhioRISE webpage for more information on OhioRISE.
Ohio Children’s Initiative CANS IT System: Please contact the ODM ITS mailbox and include “OhioRISE-CANS ” in the subject line for faster routing.