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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. ODM is holding office hours for community partners and providers to raise questions to OhioRISE subject matter experts to help implement and operationalize 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 implement and operationalize the program.

OhioRISE Implementation Office Hours

All community partners and providers are invited to attend these office hours available each Tuesday from 2-3 p.m. starting July 5 to August 30. 

Meeting Date and Time Meeting Link
Every Tuesday from 2-3 p.m. starting July 5 to August 30 Click here to join

 

Family and Children First Council (FCFC) OhioRISE Office Hours 

All FCFCs are invited to attend these office hours available bi-weekly on Wednesdays from 4-5 p.m. starting July 20 to September 28. 

Meeting Date and Time Meeting Link
Every second Wednesday from 4-5 p.m. starting July 20 to September 28 Click here to join

 

Public Children Services Association (PCSA) OhioRISE Office Hours 

All PCSAs are invited to attend these office hours available each Friday from 10-11 a.m. starting July 22 to August 26. 

Meeting Date and Time Meeting Link
Every Friday from 10-11 a.m. starting July 22 to August 26  Click here to join

2. OhioRISE Provider Enrollment During System Transition

Effective Aug. 1, 2022, ODM will not be accepting new provider enrollment applications through the MITS Provider Enrollment System. Due to the July 1, 2022, launch of the OhioRISE program, organizational or individual practitioners who will be providing services covered by the OhioRISE program may enroll with Medicaid and add OhioRISE provider specialties between Aug. 1 and Sept. 30, 2022, to begin providing and billing for services. For guidance on this process, please view the OhioRISE Provider Enrollment During System Transition Guidance.

Effective Oct. 1, 2022, all provider enrollment applications must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) module. After its implementation, the PNM module will be the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service.

3. OhioRISE Ohio Administrative Code (OAC) Rules

May 2022: OhioRISE Care Coordinator Years of Experience Guidance and Application for Partially Meeting Years of Experience

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 to become effective on July 1 for the launch of OhioRISE. 

Since January 2021, we have held 49 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

4. 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.

5. 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.

6. OhioRISE Encounter Data Quality Measures

7. 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

8. Contracting with ODM's MCOs

Until ODM goes live with Centralized Provider Credentialing in October 2022, managed care organizations (MCOs) will continue to credential providers. With limited exceptions, every provider must also be enrolled in the Medicaid program. For current information about provider credentialling, contact each MCO via the provider relations contact information listed 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/
*Administered by Paramount Advantage in West and Northeast Region until implementation of the Next Generation MCOs before the year ends.

UnitedHealthcare Community Plan of Ohio

 ​800-600-9007​

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

9. Contracting with ODM's Next Generation MCOs

Providers interested in contracting with Ohio Medicaid’s Next Generation MCOs can contact them using the provider relations contact information listed below. All managed care providers are also required to be enrolled in the Ohio Medicaid program. Additional information about how to enroll as a provider with ODM can be found at medicaid.ohio.gov/resources-for-providers/enrollment-and-support/provider-enrollment.

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

AmeriHealth Caritas Ohio, Inc.

1-833-296-2259​ 

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

Anthem Blue Cross and Blue Shield*

1-800-462-3589

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

*Administered by Paramount Advantage in West and Northeast Region until implementation of the Next Generation MCOs before the year ends. 

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/

Humana Healthy Horizons in Ohio

1-877-856-5707

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

Molina Healthcare of Ohio, Inc.  ​

1-855-322-4079​

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

UnitedHealthcare Community Plan of Ohio

 ​800-600-9007​

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

10. Educational and Member Materials for Distribution

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 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 here 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.

11. OhioRISE CANS Assessment Flyers

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. 

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.

12. OhioRISE MRSS Flyers 

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

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.

13. 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.