Important Update: Next Generation of Ohio Medicaid

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.

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.

Attention Providers: Ensure Accurate and Timely Claims Submission

Check your Trading Partner (TP) readiness to ensure accurate and timely claims submission. We created an easy-to-use spreadsheet to check your TP readiness for the February 1 launch. Visit our Trading Partners page to learn more.