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.
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.
New Surgical Quality and Safety Management Program
Buckeye is pleased to announce the launch of a new and innovative Surgical Quality and Safety Management Program, effective February 15, 2018. The program is designed to work collaboratively with physicians to promote patient safety through the practice of high quality and cost-effective care for Buckeye members undergoing Musculoskeletal Surgical Procedures. A notice was recently mailed to all affected providers.
Prior Authorization for medical necessity and appropriate length of stay (when applicable) has been delegated to TurningPoint Healthcare Solutions, LLC. and will be required for some surgical procedures in both inpatient and outpatient settings.
Please see the full letter with list of procedures and CPT codes below:
- Surgical Quality and Safety Management Program - Provider Notice (PDF)
- Prior Authorization CPT Codes (PDF)
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.
MyCare Long Term Care Program Changes
Beginning on November 1, 2017, new MyCare members who enroll in Buckeye Health Plan (Buckeye) will have their care managed by Buckeye’s RN Care Managers. The Buckeye Care Managers will communicate directly with you regarding the medical management of your patients as there will no longer be an Optum Nurse Practitioner assigned to your patient’s care.
On January 1, 2018, the Buckeye Care Managers will assume care management responsibilities for all enrolled MyCare members residing in Nursing Facilities, and Optum Nurse Practitioners will no longer be responsible for the medical management of any MyCare members enrolled in Buckeye.
Buckeye is actively working on contracting with Nurse Practitioners throughout Ohio to provide medical management services to our MyCare members upon referral from the member’s physician and/or the Buckeye Care Manager. The Care Manager will notify you regarding referrals to the Nurse Practitioner for any of your patients. We appreciate the care that you provide for Buckeye’s MyCare members. We are available to discuss any questions or concerns with you. You can reach one of our representatives at 1-866-246-4358. Answers to frequently asked questions and other resources are also available on our website.
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.