Provider Network Management Module and Centralized Credentialing
After undergoing a timeline review to ensure optimum testing and readiness, the Ohio Department of Medicaid (ODM) along with the Department of Developmental Disabilities (DODD) and Ohio Department of Aging (ODA) will undertake a phased approach and go-live for the Provider Network Management (PNM) module and Centralized Credentialing projects. The anticipated go-live dates for each phase are:
PNM & Centralized Credentialing - Phase 1 (July 26, 2021)
- One Front Door provider enrollment
- Provider credentialing
- Provider self-service (demographic updates, group affiliations)
- Enhanced provider directory
PNM Portal Functionality - Phase 2 (December 20, 2021)
- Claim submission (fee-for-service) / searches
- Prior authorization submission / searches
- Member eligibility verification
- Hospice member functions
Provider Network Management (PNM)
What is PNM?
ODM is in the process of modernizing its management information systems. This modernization roadmap, developed in accordance with the Centers for Medicare and Medicaid Services (CMS) guidance, includes a transition to a modular system called the Ohio Medicaid Enterprise System (OMES) that will support ODM in meeting several modernization goals.
As a part of this roadmap, updated and new functionality is being built into OMES rather than MITS. The Provider Network Management (PNM) is a new modular component of OMES that will replace the current MITS provider enrollment subsystem and the current MITS provider portal.
What benefits are coming with PNM?
There are several new features and enhancements in the PNM that are designed to streamline processes and reduce administrative burdens for providers.
- Accepts the same National Provider Identifier (NPI) for multiple provider types and allows multiple provider Medicaid IDs to be associated to one NPI. (Phase 2)
- Gives providers the ability to view specialties and effective dates.
- Provider change or update requests submitted in the PNM can also be reviewed and accepted within the PNM. There is no need for email or letters. (Includes change of operator notices, name changes, adding specialties, etc.)
- Provides a comprehensive provider directory at the state level.
- Providers may opt in or out to text message notification options for providers.
- No more paper agreements for long term care facilities – all agreements are available online and do not require mailing back and forth for signatures.
What is Centralized Credentialing and what benefits will it provide?
ODM is implementing a single, centralized provider credentialing process at the state level with the go-live of the PNM module. There are many expected benefits of this centralized approach, including:
- Providers subject to credentialing will only undergo one credentialing and recredentialing process at the state level vs. a separate additional process for each Ohio Medicaid managed care organization (MCO).
- A Credentialing Verification Organization (CVO) – Maximus, Inc. – will maintain NCQA accreditation requirements for Ohio’s MCOs and serve as ODM’s single point of contact for providers as they undergo credentialing and recredentialing reviews.
- By establishing delegate agreements with hospital systems and a delegate review process, ODM can deem credentialing work already completed by these providers and reduce or eliminate the need for individual providers such as physicians, nurse practitioners, etc. to engage in multiple credentialing processes.
Centralized Credentialing Summary
What’s next for PNM and Centralized Credentialing?
ODM is establishing a Credentialing Committee, which will be chaired by ODM’s Chief Medical Officers and include participants from the provider community. ODM is also working with our MCOs to transition provider recredentialing dates into the PNM for an easy transition of currently contracted MCO providers.
Additional communications will be forthcoming to indicate cut-over / system freeze dates, training information (including registration process), and other opportunities to learn more about the PNM and Centralized Credentialing.
For questions, please reach out to the following mailboxes: