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Next Generation MyCare Program

Welcome to Wellcare By Buckeye Health Plan

 

Wellcare By Buckeye Health Plan offers a plan for individuals eligible for Medicare and Medicaid through Ohio’s managed care program, Next Generation MyCare.

The Next Generation MyCare Program is an improved healthcare program for Ohioans who have both Medicaid and Medicare that helps members get the care they need all in one plan. The Plan gives members all benefits available through the traditional Medicare and Medicaid programs, including long-term care services both in the community, assisted living, and in a nursing facility as well as behavioral health services. We are pleased to share with you the launch of the Buckeye Health Plan website pages supporting this new product starting January 1, 2026.

You’ve entered your one-stop shop to access all the information you need for this new plan:

Resources to Coordinate Care

Updates

This page will also serve as a centralized location for Next Generation MyCare Program Updates. As we move farther along in the rollout of the new program, you will find Updates to keep you current on changes or additions all in one place.

We are pleased to announce that the previously communicated system enhancements for  Wellcare by Buckeye Health Plan and Wellcare D-SNPs have been finalized. As a result, pre-payment edits will be applied for new claims processed on or after March 15, 2026.

Claims for D-SNP members will now be reviewed and validated prior to payment. This transition is designed to:

  • Improve claim accuracy
  • Support policy compliance
  • Streamline payment processing

Please note: Claims submitted prior to the pre-pay edit implementation period continue to be subject to post-payment edits, where applicable.  Any claims paid incorrectly according to policy may be subject to recoupment under standard procedures.  

Provider Responsibilities and Next Steps

We value your continued partnership and request that you review the following reminders:

  • Continue submitting complete, accurate, and timely billing information, following the guidelines outlined in your provider manual. 
    • Monitor for additional reminders or updates as we approach go-live. If you have any questions or concerns, please reach out to Provider Services.

We appreciate your partnership during this transition. Together, we ensure claims are processed accurately and compliantly.  We look forward to continuing to work together to meet State and CMS requirements.

As a reminder, all members previously enrolled in our Medicare-Medicaid Plan (MMP) experienced coverage and member ID changes at the start of the calendar year.

Claims for services rendered on or after January 1, 2026, must be submitted using the current year member ID. Please follow the steps below to avoid rejected claims and processing delays:

  • Verify eligibility to confirm the members' current coverage and member ID.
  • Submit claims for services on or after January 1 using the new Wellcare by Buckeye Health Plan member ID.
  • Do not submit claims that span December and January for dates of service under a single claim. Claims must be split and submitted under the corresponding plan for 2025 or 2026.
  • Obtain new prior authorizations for services beginning January 1, 2026, or after from Wellcare by Buckeye Health Plan.
  • Prior authorizations issued under the MMP (prior to January 1, 2026) for dates of service ending on or after January 1 will transfer with the member’s eligibility to Wellcare by Buckeye Health Plan. These authorizations will be honored and do not need to be resubmitted. The authorization number will remain the same.
  • Please note that you should use the following payer IDs for all claims submitted on or after 1/1/2026.

  • Payer IDs

    Buckeye’s Next Generation MyCare Ohio Payer IDs Effective 1/1/2026:

    • 0021583 BUCKEYE’S NEXT GENERATION MYCARE OHIO (837 P & I ONLY)
    • V004202 BUCKEYE’S NEXT GENERATION MYCARE OHIO/ENVOLVE VISION
    • D004202 BUCKEYE’S NEXT GENERATION MYCARE OHIO/ENVOLVE DENTAL (837 Dental)

     

     You may verify eligibility through our secure provider portal or Availity Essentials. If you have questions regarding a specific member’s eligibility or coverage, call Provider Services at 1-833-998-4892.

We have identified an EDI claim rejection related to provider taxonomy and NPI requirements that was incorrectly applied to some incoming claims for Wellcare by Buckeye Health Plan members. These fields are not required for Dual-eligible claims.

The rejection affected claims received on or after January 1, 2026, for dates of service on or after January 1, 2026. We are actively working to remediate this issue, and the correction is expected to be completed by January 15, 2026.

What providers need to do

  • No action is required at this time.
  • Providers do not need to resubmit claims that were rejected due to this issue.

What happens next

  • Once the issue is corrected, we will reprocess all claims that were inappropriately rejected.
  • Providers should begin to see claim status updates showing receipt of their claims approximately one week after the correction date.

We appreciate your patience while we resolve this issue.

Buckeye Health Plan was made aware that there were delays with trading partners receiving the 277CA Claim Acknowledgment for claims submitted through the One Front Door Fiscal Intermediary for MyCare Next Generation Members. The issue has been corrected 01/06/2026 and the Acknowledgements are in the process of being resent for distribution to OMES  (Ohio Medicaid Enterprise System) who will distribute to the trading partners. 

Every provider is sent their registration codes. They are unique to the provider for each line of business. If the provider cannot find the email that would have been sent, they can call Payspan’s provider customer service. There will be a few steps, for security reasons, they will have to go through. Then they will be helped out setting things up.

PaySpan Customer Service
877-331-7154 Option 1, 8:00a to 8:00p ET
providersupport@PaySpanhealth.com

Ensuring members receive care is the Ohio Department of Medicaid’s priority. To verify if an individual is enrolled in a Next Generation MyCare plan, you can take the following actions

  1. Check the Member ID Card. If the ID card has a Next Generation MyCare program logo it is indicative that the member is a Next Generation MyCare member.
  2. Check member eligibility via Provider Network Management (PNM) or the Electronic Data Interchange (EDI) 270/271 process.

If after completing these steps you encounter issues verifying a member’s enrollment, we encourage you to provide the member services and follow existing billing guidance at https://medicaid.ohio.gov/resources-for-providers/billing/billing. If you have questions or need help, call the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov. Representatives are available Monday through Friday, 8 a.m. – 4:30 p.m. Eastern Time.