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Learn more about the next generation of Ohio Medicaid managed care and what it means for providers

IMPORTANT UPDATE: Ohio Medicaid is upgrading its provider enrollment system

Effective August 1, 2022, ODM will not be accepting new provider enrollment applications or continue any in-progress 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 available on the Resources for Community Partners and Providers page of the OhioRISE webpage.

Effective October 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.

About Ohio Medicaid's Next Generation Program

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: On October 1, 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: On December 1, 2022, the implementation of the Next Generation managed care plans will occur. 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.

Next Generation Ohio Medicaid Program Provider Overview Webinar

The Ohio Department of Medicaid (ODM) recently hosted the Next Generation Ohio Medicaid Program Provider Overview Webinar to share information in preparation for the Next Generation program's October 1, Stage 2 launch. This webinar covered the exciting changes Ohio Medicaid providers can expect, including an overview of the transition to the Ohio Medicaid Enterprise System (OMES) modules, training plans and dates, and where providers can receive communications from ODM throughout the Next Generation transition and implementation.

Please see below for a recording of the session and the corresponding slides.

Want to learn more about the benefits Ohio Medicaid members and providers will experience through the Next Generation program Stage 2 launch? Check out the PNM & Centralized Credentialing and Single Pharmacy Benefit Manager (SPBM) pages of this website. Please also subscribe to the ODM 2022 Press, our provider newsletter, to stay up to date on upcoming changes.

For questions about the Next Generation program, please contact ODMNextGen@medicaid.ohio.gov.

Registration is open for Provider Network Management (PNM) Training!

Training and Learning Management System

In preparation for Stage 2 go-live (Oct. 1, 2022), we are offering a variety of training options including self-paced, virtual, and in-person training options. Absorb, the Learning Management System (LMS), is where you will access the self-paced training and sign up for the virtual and/or in-person sessions.

LMS Registration

Training sessions are scheduled to begin Aug. 1, 2022, and it is important that you create an account in the LMS to ensure you have access to all training sessions, answer forms, and PNM resources in advance. Visit the Job Aid to access the LMS and follow the steps to create your account and register for training.

Contracting with ODM's Current Managed Care Organizations

Until ODM goes live with Centralized Credentialing on October 1, 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 on October 1, 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​

     

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

Once live on October 1, 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.

Communicating with ODM

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.