If you are a contracted Buckeye Health Plan provider, you can register now. If you are a non-contracted provider, you will be able to register after you submit your first claim.
Once you have created an account, you can use the Buckeye Health Plan provider portal to:
- Verify member eligibility
- Manage claims
- Manage authorizations
- View patient list
Behavioral Health Providers
Please click on the "Resources" link below to access the provider manual, training materials or to join our network.
Is your patient pregnant, or thinking about becoming pregnant? Please click on the "resources & forms" link below to access Buckeye's "Pregnancy and Prenatal" resources.
In the "Pregnancy and Prenatal" drop-down menu, you will find Buckeye's Notification of Pregnancy (NOP) form and instructions to submit the web-based Pregnancy Risk Assessment Form (PRAF 2.0) via NurtureOhio's website.
Nursing Facilities & Hospice Providers
Effective July 1, 2019, the Ohio Department of Medicaid is requiring Buckeye and all Ohio Medicaid Managed Care Plans to pay room and board payments to the hospice provider when the individual member resides in a nursing facility and is receiving hospice services. The hospice provider will bill Buckeye for room and board services. This payment would also include reimbursement for vent and vent weaning services when provided by facilities participating in the ODM Nursing Facility Ventilator Program and including the identified diagnosis and revenue codes. This is Buckeye’s current payment methodology. As a result, providers will not experience a change in reimbursement for Buckeye members’ claims.
If you have questions regarding the Nursing Facility ventilator program and the associated coding and reimbursement, you may click the following link for more information: https://medicaid.ohio.gov/Portals/0/Providers/ProviderTypes/LongTermCare/FactSheets/Ventilator.pdf.
For questions regarding Buckeye’s policy, please contact our Provider Services Department at 866-296-8731.
Waiver Provider Signature Requirement: Ohio Department of Aging (ODA) and Ohio Department of Medicaid (ODM)
As of 12/31/18, waiver service providers for the Assisted Living, MyCare, Ohio Home Care and PASSPORT waivers are required to sign the individual’s person-centered service plan (service plan). This change meets the Centers for Medicare and Medicaid Services’ (CMS) 42 CFR 441.301 rule requiring the service plan “be finalized and agreed to, with the informed consent of the individual, in writing, and by all people and providers responsible for its implementation.”
Please view Buckeye's News Post for more information on the waiver requirement and contact information if you have questions.
Ohio Department of Medicaid: Updates on EVV Implementation
The Ohio Department of Medicaid (ODM) has provided updates regarding Ohio's implementation of electronic visit verification (EVV). These updates were emailed to all providers. Please review the communcations to check whether you will be impacted by these updates.
EVV is an electronic-based system that verifies when provider visits occur and documents the precise time services begin and end. Ohio's EVV is being implemented in three phases, and the communicaiton provides details about which providers are impacted by Phase 2 of the implementation, which will being on August 5, 2019. Phase 2 EVV implementation will apply to the following services:
- State Plan Home Health Aide
- State Plan Home Health Nursing
- State Plan RN Assessment
- HCBS 1915c Waiver Nursing
- HCBS 1915c Waiver Personal Care Aide
- HCBS 1915c Waiver Home Care Attendant
- Private Duty Nursing (PDN)
To learn more about the implementation and next steps, please visit ODM's website.
For questions, please contact the ODM EVV Unite at EVV@medicaid.ohio.gov.
Provider Alert: Claims Payment System Error Notifications
Beginning October 1, 2018, Buckeye will send notice to providers when an error in our claims processing system impacts five or more providers. The notices will include specific information regarding the error, how claims will be corrected, and the estimated date of correction. Copies of each notice are available on our Provider Resources webpage under the CPSE drop-down menu. Please contact Buckeye Provider Services at 1-866-296-8731 with any questions.
Member Care Management Review
Providers, did you know that you can review your member's plan of care on Buckeye's Provider Portal? Log on to Buckeye's Secure Provider Portal to view this information along with member health risk assessment results as part of the electronic medical record.
Buckeye Health Plan offers health insurance programs that fit the unique needs of our members.
View all of our available programs below. Select one to view more information and resources for our plan.
Health Insurance Marketplace
The Health Insurance Marketplace is an online shopping mall of healthcare plans. Buckeye Health Plan's plan is called Ambetter. Ambetter offers affordable health care coverage for individuals and families. Depending on family size and income, a person may even qualify for help to pay their monthly premium.
The Medicare-Medicaid Plan (MMP) is a joint effort between the Ohio Department of Medicaid (ODM) and the Centers for Medicare and Medicaid Services (CMS). Buckeye Health Plan – MyCare Ohio (Buckeye) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. The goal of this program is to improve the experience in accessing quality, coordinated care.