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Welcome to the Buckeye Provider Home Page

Being a trusted partner with our providers is a top priority. We must earn that trust every day, with every interaction. Based on your feedback, we have begun implementing a communication plan to enhance our provider messaging and communications. Please let us know if you have suggestions. We have a feedback form on the bottom of our What We Have Done For You Lately page.

Updates You Need to Know

  • Aug 29: Policy Updates Effective October 1, 2025
    • Problem Oriented Visits Billed with Surgical Procedure Payment Policy CC.PP.052
    • E&M Services Billed with Treatment Room Revenue Codes Policy CC.PP.071
    • Problem Oriented Visits Billed with Preventive Visits Policy CC.PP.057
    • Optum CPI Update Notification for Buckeye Health Plan (Claim Edits)
  • Aug 29: Prior Authorization Updates Effective October 1, 2025
    • Updated Prior Authorization requirements for code G0483 (Medicaid) Effective October 1, 2025
    • Evolent Prior Authorization Updates effective October 1, 2025 (All LOBs)
    • Ambetter (Marketplace) Billing Code H0019 requires Prior Authorization effective October 1, 2025.
    • Effective October 1, 2025, Ambetter Important Update for S5000 and S5001 codes with Charges Over $500 (Ambetter)
    • Update to S5000 drug generic effective 10-1-25 (Medicaid)
  • Aug29: Prior Authorizations Effective October 15, 2025
    • Wellcare by Allwell (Medicare) Prior Authorizations effective October 15, 2025
    • Ambetter Prior (Marketplace) Authorizations effective October 15, 2025
    • Buckeye Health Plan (Medicaid) Prior Authorizations effective October 15, 2025
  • Jul 30 - PCP Accountability for Home and
                 Community-Based Services - ODM
                 Requirements
  • Jul 30 - ODM Extends Timeline for Using Sterilization
                 Consent Form
  • Jul 30 - Secondary Ventilator Requirements - CMN to be
                 submitted with secondary vent claim
  • Jul 30 - Pre-Authorization Requirement - Lab Codes -
                 Effective Immediately
  • Jul 30 - tango-WellSky Update
  • Jul 30 - Prior Authorization Updates Effective 9-1-25  
  • Jul 30 - Medicaid Prior Auth Optimization OP Code
                 Updates Effective 9-1-25
  • Jul 18 - Payment Policy OH.PP.076 Emergency
                 Dept E&M Leveling for Professional Services
                 Effective 9-1-25
  • Jul 18 - Payment Policy OH.PP.066 Office-Based E&M
                Overcoding Effective 9-1-25
  • Jul 18 - Payment Policy CC.PP.067 Renal Hemodialysis
                 Effective 9-2-25
  • Jul 18 - Payment Policy CC.PP.075 Optum Newborn
                 IP Stays Effective 9-1-25
  • Jul 18 - Optum CPI Update Notification effective 9-1-25
  • Jul 14 - Polypharmacy Anticholinergic Medications -
                 Star Measure

Secure Provider Portal Login

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
  • Login/Register

LOGIN/REGISTER

Sign Up for our Monthly Provider Bulletin

ODM All Provider-All MCO Semi-Annual Meeting

For all EVV and Sandata information please see:

Provider Services

Medicaid and MyCare Ohio

Monday - Friday  7 a.m. to  8 p.m
866.296.8731

Wellcare by Allwell

Monday - Friday  8:00 a.m. - 8:00 p.m. M-F at  855.766.1851

Ambetter

Monday - Friday 8 a.m. - 5 p.m.
877.687.1189 

Key Provider Information:

 

Provider Quick Links

icon: go to pre auth check

PRE AUTH CHECK
icon: Submit a claim or check claim status

SUBMIT CLAIM/CHECK CLAIM STATUS
icon: go to preferred drug list

PREFERRED DRUG LIST

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.

Medicaid

Buckeye Health Plan is a care coordination plan contracted with the Ohio Department of Medicaid to serve Medicaid and other government services program members. Buckeye has developed the expertise to work with Medicaid members to improve their health status and quality of life.

MyCare Ohio

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.

Medicare

Buckeye Health Plan Advantage is an HMO SNP plan with a Medicare contract and a contract with the Ohio Medicaid program. Enrollment in Buckeye Health Plan Advantage depends on contract renewal. This plan is available to anyone who has both Medical Assistance from the State and Medicare.

Provider Newsroom Prior to July 1, 2020

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