Welcome & Overview

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Communications and Updates

Welcome New Providers

MyCare Ohio Program Overview One-Pager

MyCare Ohio Waiver Overview One-Pager

See a complete list of specialty providers.

Why Providers Prefer Buckeye

Member Website Information

Member Services: 866.246.4358

Member ID Cards

Enrollment & Support

Provider Network Management

Centralized Credentialing

Next Generation MyCare Non-Contracted Provider

Become a Provider – Join Our Network

Care Coordination

Please note, members coming on plan from another MCO have 90-days continuity of care to continue services with their non-contracted providers and 365-days when coming on plan from other waiver types.  Providers can Join Our Network or assist members in transitioning to a Contracted Provider.

Next Generation MyCare Program Care Coordination One-Pager

Billing & Claims

Electronic Transactions

PaySpan – EFT/ERA

Clinical & Payment Policies

Companion Guides

Claims Escalation

Waiver Provider Billing

Claims submission information: Please see our Provider General Billing Information and General Billing Guidelines Provider Manual

In February 2023, Ohio Department of Medicaid transitioned to the Ohio Medicaid Enterprise System (OMES) implementing the new Fiscal Intermediary (FI) streamlining operations and improving efficiency for both providers and the state.

To summarize the key points:

• OMES Modernization: Replaces the older Medicaid Information Technology System with a modular, CMS-aligned system.
• Fiscal Intermediary (FI): Now handles claims and financial transactions, replacing the legacy subsystems.
• Next Generation MyCare Ohio: Will utilize the FI to centralize and streamline claims and prior authorization processes.
• Provider Impact: All Medicaid and MyCare Ohio claims and prior authorizations must now go through the FI.

To learn more about the Fiscal Intermediary please see the below links.

Fiscal Intermediary

Submitting Claims through the Fiscal Intermediary

New Buckeye Payer IDs effective 1/1/2026:

•  0021583 – BUCKEYE Next Generation MyCare
  (837 P & I ONLY)
•  V004202 – BUCKEYE/ENVOLVE VISION
•  D004202 – BUCKEYE/ENVOLVE DENTAL (837 Dental)

It is important that providers ensure Buckeye has accurate billing information on file.

Please provide accurate information as follows:

• Provider name (as noted on his/her current W-9 form)
• Physical location address
• Billing name and address (if different)
• Tax Identification Number

Claims eligible for payment must meet the following requirements:

• The member is effective on the date of service;
• The service provided is a covered benefit under the member’s contract on the date of service; and
• Referral and prior authorization processes were followed, unless the service was an emergency service.
• For detailed information, please refer to the Provider Manual or, call Buckeye’s Provider Services Department at 866-296-8731. 
• Payment for service is contingent upon the service being provided to treat an emergency, or the service was in compliance with referral and prior authorization policies and procedures, as well as the billing guidelines.
• For Buckeye members, all claims and encounters should be submitted to the general claim department address listed in our Provider Manual, unless it’s a specialty service as noted. --Cont'd next column.

Please note, to be reimbursed for Medicaid or MyCare services, providers must have an active Medicaid number with the Ohio Department of Medicaid (ODM).  To obtain a Medicaid number, follow one of the steps listed below:

• Enroll directly through ODM’s provider network management system  Select “MCP Single Case” tile to begin a new provider enrollment application. Upon approval, your Medicaid number will be active for 5 years.  (Preferred method)
• If you do not wish to complete the PNM process online please complete both the ODM 10282 and 10283 forms.  Return the forms by fax to 1.844.918.1075 or email OH_SingleCaseAgreements@Centene.com 
  Once approved, your Medicaid number will be active for 5 years. 
• If you do not wish to complete steps 1 or 2 to fully enroll with ODM, you must complete and return the ODM 10295 form within seven calendar days to the fax or email above to obtain a 120-day temporary Medicaid number.  
• Question/inquiries about enrolling with the Ohio Department of Medicaid please contact the IHD Command Center Hotline 800-686-1516 (option 2; sub-option 2).

Envolve Dental
844.464.5634
Fax:844.847.9807

Dental Claims Submission
PO Box 22687
Tampa, FL 33622-2687
844.464.5634

Envolve Vision
Provider Services 866.442.6173
Customer Service 800.840.7032

Vision Claims Submission
Envolve Vision Attn: Claims
PO Box 7548
Rocky Mount, NC 27804
866.442.6173

Authorizations & Utilization Management

UM Escalation Process

Pre-Auth Check

Waiver Authorizations

Non-Waiver Authorizations

Provider Types

Hospice Services

HCBS Services

Ohio Home Care Waiver

Clinic Providers

Hospital Provider Information

Home Health Services

Nursing Facilities

Electronic Visit Verification (EVV)

Electronic Visit Verification Overview

Sandata On-Demand

Policies & Training

Next Generation MyCare Trainings

Managed Care Rules and Requirements

Buckeye expects our network providers to follow Ohio’s managed care rules and requirements. Please familiarize yourself with key requirements to ensure compliance.

• Ohio Administrative Code – Chapter 5160-26External Link – View managed care plan requirements from the Ohio Administrative Code.
• Ohio Revised Code – Chapter 5167External Link – View Medicaid managed care requirements from the Ohio Revised Code.

Sample Network Provider Agreement

• OH Participating Provider Agreement (PDF)

NextGen Buckeye Medicaid Base Provider Agreement. This is to give providers who are not currently contracted with Buckeye an idea of our participation requirements.

• OH Provider Product Attachment (PDF)

Regulatory Amendment adding new NextGen required contract language to provider agreements.  This is to give providers who are currently contracted with Buckeye an idea of the new NextGen participation requirements.

If you would like to complete and submit a request to participate, please see our Become a Provider section.