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Next Gen Contract Information

Next Generation Managed Care

Buckeye Health Plan is pleased to have been selected to continue serving Ohio Medicaid recipients throughout the entire state of Ohio. This page compiles resources to support our providers through the implementation of the Ohio Department of Medicaid’s (ODM’s) Next Generation Managed Care.

Overview

ODM’s changes to Medicaid program administration will streamline and simplify administrative tasks between providers and managed care entities (MCEs). These changes will create a single front door approach that focuses on care for the individual member.

Latest information regarding the ODM Next Generation 2022 Contract 

Helpful Links

 

Member ID Cards


 

Centralized Credentialing

ODM is implementing a new Provider Network Management (PNM) module and centralized credentialing.

IMPORTANT UPDATE:

Ohio Medicaid is upgrading its provider portal. Effective August 1, 2022, ODM will not be accepting new provider enrollment applications or continue any in-progress enrollment applications through the MITS Provider Enrollment System.

Due to the July 1, 2022, launch of the OhioRISE program, organizational or individual practitioners who will be providing services covered by the OhioRISE program may enroll with Medicaid and add OhioRISE provider specialties between Aug. 1 and Sept. 30, 2022, to begin providing and billing for services. For guidance on this process, please view the OhioRISE Provider Enrollment During System Transition Guidance document.

Effective October 1, 2022, all provider enrollment applications must be submitted using Ohio Medicaid's new Provider Network Management (PNM) module. After its implementation, the PNM module will be the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service.


Fiscal Intermediary

ODM is implementing a fiscal intermediary (FI) to streamline claim and prior authorization submissions. The FI will serve as the central point of intake for transactions and will assist in transitioning claims and authorizations to, as well as receive updates from, Buckeye. Providers will be required to submit Medicaid claims and request for prior authorization to the fiscal intermediary.


Buckeye's OhioRISE Overview Website Page

OhioRISE Training


See our Buckeye SPBM website page for more details and training.

ODM is contracting with a new, specialized managed care organization to administer Ohio Medicaid’s prescription drug program. This new Single Pharmacy Benefit Manager (SPBM) will monitor quality, transparency and accountability for Buckeye.


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.


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. 

Questions?

Contact our Provider Services team at 866.296.8731. We are open Monday - Friday from 8 a.m. to noon and 1- 5 p.m.