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Learn more about the Next Generation of Ohio Medicaid program and what it means for providers, including available resources to support you in utilizing new systems and features.

Over the past year, Ohio Department of Medicaid (ODM) has prepared for and successfully launched many components of the Next Generation of Ohio Medicaid program. ODM’s implementation has consistently followed two of its key Next Generation commitments – to focus on the individual and improve the provider experience. To meet these commitments, ODM has implemented the following components: 

  • On July 1OhioRISE began providing specialized services that help children and youth with behavioral health needs and help coordinate care for those who receive care across multiple systems.  
  • On October 1, the Centralized Provider Credentialing initiative began, and it has reduced administrative burden on providers. Also, the Single Pharmacy Benefit Manager (SPBM) began providing pharmacy services across all managed care plans and members. 

Our focus has been and continues to be on implementing new components and improvements as they are fully ready to support achieving our mission. ODM remains committed to listening to members, providers, and managed care plan partners, and we have taken a hands-on approach to resolving implementation issues that have been experienced by providers. ​Leading up to our next implementation, we have been actively seeking input from stakeholders and conducting testing of all systems.

Based on the feedback we have received and our commitment to carefully transitioning, we will not implement the new Next Generation managed care plans and the full Ohio Medicaid Enterprise System (OMES) launch on December 1. The new lineup for implementation is as follows:

  • On February 1, 2023, ODM will launch the Next Generation managed care plans and program requirements, including exciting improvements that will support members in accessing the healthcare services and supports they need. ODM will also implement the new Electronic Data Interchange (EDI), increasing transparency and visibility of member care and services.
  • Subsequently, ODM will fully launch OMES modules to provide streamlined processes for claims, prior authorizations, and other administrative tasks for providers.

Providers should continue conducting business as you do today on and after December 1 – including the processes, procedures, and systems used today to submit claims, prior authorizations, and complete other administrative functions. In addition to this, PNM functionality will remain the same. ODM will provide more information about the upcoming implementation for members and providers in the coming weeks.