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In 2019, the Ohio Department of Medicaid (ODM) launched a series of procurements and strategic initiatives with the goal of creating a Next Generation managed care program focused on the individual. This focus supports us in doing better for the people we serve and the providers who are our partners.

The Next Generation of Ohio Medicaid program will be implemented in stages to avoid unnecessary disruption and confusion for members and to reduce burdens on our service providers. The Next Generation program will be implemented in the following stages: 

Stage 1: On July 1, 2022, OhioRISE will begin providing specialized services, which will help children and youth with behavioral health needs and help coordinate care for those who receive care across multiple systems.  

Stage 2: In October 2022, Centralized Provider Credentialing will begin which will reduce administrative burden on providers. Also, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members. 

Stage 3: Immediately following stage two, and before the year ends, our attention will turn to the implementation of the Next Generation managed care plans. Members will experience benefits that help address their individual health care needs such as increased access to care coordination and care management supports. Also in stage three, ODM will implement additional improvements to streamline the process of claims and prior authorization submission for providers.

To learn more about the Next Generation of Ohio Medicaid and the staggered implementation, check out the Ohio Medicaid Providers Factsheet.

Contracting with ODM's Current Managed Care Organizations

Until ODM goes live with Centralized Credentialing in October 2022, managed care organizations (MCOs) will continue to credential providers. Please contact each MCO for current information about provider credentialing.

Medicaid Managed Care Organization Enrollment / Credentialing Contact Information
MCO   Phone Number Web Address
Buckeye Community Health Plan

1-833-296-2259​ 

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

CareSource Ohio, Inc.

1-833-623-1513​

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 and Blue Shield* (Operated by Paramount Advantage)

1-800-891-2542

https://www.paramounthealthcare.com/services/providers/join-our-network/

UnitedHealthcare Community Plan of Ohio

1-800-600-9007

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

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

Once live in October 2022, Centralized Credentialing will simplify the credentialing process for Medicaid providers; providers will no longer seek credentialing through each MCO.

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 implementation of the Next Generation MCOs before the year ends. 

Once live in October 2022, Centralized Credentialing will simplify the credentialing process for Medicaid providers; providers will no longer seek credentialing through each MCO.

Contracting with the OhioRISE Plan

Providers interested in contracting with Aetna to provide behavioral health services to children and youth enrolled in the OhioRISE program are encouraged to contact Aetna Better Health of Ohio. Providers 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 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.

The 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.

New OhioRISE Provider Specialties Are Available 

As of March 9, several new provider specialties associated with the implementation of the OhioRISE program are available to you. ODM requires that providers add a provider specialty to their provider enrollment type in order to bill for some new and enhanced services under this program and as part of the Next Generation of Ohio Medicaid. For additional information about the new specialties and their requirements, click here to view the OhioRISE Provider Specialties Guide.

Enrolled Providers: If you are currently enrolled as an ODM provider, plan to offer any of the new and enhanced services, and have the appropriate certification/documentation, please email ODM at Medicaid_Provider_Update@medicaid.ohio.gov as soon as possible. Request that the applicable specialty for the new service be added to your existing provider type, include your NPI and Ohio Medicaid ID, and attach required documentation.

New Providers: If you are a provider who is not currently enrolled in the Ohio Medicaid program and wish to enroll to provide any services under the Next Generation of Medicaid, please visit the following link to the Ohio Medicaid online application: https://portal.ohmits.com/Public/Providers/Enrollment/tabId/49/Default.aspx. If your enrollment requests the addition of more than one specialty, after your enrollment is complete, please email ODM at Medicaid_Provider_Update@medicaid.ohio.gov to submit the required documentation for the new specialties.

Enrolling as a Medicaid provider and/or adding the appropriate OhioRISE provider specialty to your enrollment will allow you to bill ODM for the new services you provide to OhioRISE-enrolled children starting July 1. You must have the appropriate OhioRISE provider specialty added to your enrollment in order to bill Medicaid for the new OhioRISE services listed above on and after July 1, 2022. To avoid delays in claims payment after July 1, it is critical for providers to add these specialties as soon as possible.

Communicating with ODM

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.  will remain open as a way for providers to communicate with ODM about the current Medicaid managed care program. For feedback or observations related to the Managed Care Procurement, you can also contact us through the Next Generation mailbox or by visiting the Contact Us page.