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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 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.