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.
- Next Generation of Ohio Medicaid Managed Care – Learn about the Ohio Medicaid Managed Care program.
Latest information regarding the ODM Next Generation 2022 Contract
Do you have your OH|ID?
Be ready for changes coming to Medicaid beginning October 1.
Beginning October 1, all Buckeye Health Plan Medicaid providers will need an OH|ID, the State of Ohio’s digital identity standard, to access Medicaid’s new Provider Network Management (PNM) module and the single pharmacy benefit manager (SPBM) secure web portal.
If you missed the September 23 PNM preregistration deadline, you can still get your OH|ID – the first step to securely access Medicaid enterprise systems.
Why this is important:
The OH|ID is required to securely access state agency systems. It gives providers a single set of logon credentials to securely access state agency systems, including Medicaid’s, from any device. The ID adheres to best practice security and privacy regulations as defined by the National Institute of Standards and Technology (NIST). Agencies and users using the OH|ID can rest assured that their digital identities are kept safe and secure. The OH|ID
Get your State of Ohio digital identification - the OH|ID today.
Beginning October 1:
Anyone accessing the PNM or the SPBM secure web portal when they go live on October 1 will need an OH|ID to log in and complete key administrative tasks and processes. The following resources are available to providers to assist in setting up an account.
Providers needing technical assistance should contact the Ohio Department of Medicaid Integrated Help Desk (IHD) at 800.686.1516. Hours of operation are Monday-Friday, 8 a.m. - 4:30 p.m. ET.
Are you ready for changes coming to Ohio Medicaid on October 1?
To submit claims and prior authorizations or update enrollments as of October 1, you’ll need to preregister with your OH|ID for the Provider Network Management (PNM) module by September 23.
In July, ODM hosted a webinar for providers on the Next Generation's Stage 2 October 1 launch. This webinar included an overview of the new modules and upcoming provider training plans and dates. Please see below for a recording of the session and the corresponding slides.
- Next Generation Ohio Medicaid Program Provider Overview Slides
- Next Generation Ohio Medicaid Program Provider Overview Recording
You can also check out the PNM & Centralized Credentialing and Single Pharmacy Benefit Manager (SPBM) webpages. For questions about the Next Generation program, contact ODMNextGen@medicaid.ohio.gov.
We are excited to announce that the PNM Pre-Registration tool is live! As a reminder, the Ohio Department of Medicaid (ODM), Department of Developmental Disabilities (DODD), and the Ohio Department of Aging (ODA) are implementing a new Provider Network Management (PNM) module on October 1, 2022. The PNM module will replace the current MITS provider enrollment subsystem and MITS provider portal and will require an OH|ID for provider access. The PNM Pre-Registration tool will be available from August 15 until September 23 and will ease the transition and prevent disruptions to system access for providers ahead of go-live on October 1, 2022.
How do I access the PNM Pre-Registration tool?
Please visit PNM Pre-Registration tool directly to access the tool directly. You can also access the PNM pre-registration tool through a link on the PNM & Centralized Credentialing page. From there, you will be able to begin the pre-registration process. For providers who have already created an OH|ID, the pre-registration process will only take a few minutes as you will simply connect your existing account to the PNM module.
What should I do if I don’t have an OH|ID yet?
The PNM Pre-Registration tool will automatically redirect you to the OH|ID account creation site, but you can also create an OH|ID in just a few minutes using the steps below:
- Go to OH|ID Login.
- Fill in the appropriate fields with user information and create account.
- An email confirmation will be sent following registration.
- Once you have logged in, please fill in the required fields with the correct security information and address any error messages that appear if you complete the security questions unsuccessfully.
Need Help?
To learn more about the PNM module and Centralized Credentialing, visit the PNM & Centralized Credentialing site. If you have questions about OH|ID, please visit the OH|ID Help Center (Please note: OH|ID account log in is required to access this site.)
Provider Enrollment and Maintenance Update
Beginning Aug. 1, the Ohio Department of Medicaid (ODM) will temporarily stop accepting provider enrollment applications as we transition to the new Provider Network Management (PNM) module. New providers should enroll by July 31 or plan to hold enrollment applications until Oct. 1. Information about OhioRISE provider enrollment during this time is forthcoming.
If you are a provider who is not currently enrolled and wish to enroll to provide any services under the Next Generation of Ohio Medicaid, please visit the link to the Ohio Medicaid online application by July 31:
Beginning Aug. 31, all provider demographic and agent maintenance update functionality will be closed for conversion of data in MITS. Enrolled providers should update their demographic information in MITS by Aug. 30 or plan to hold updates until Oct. 1. Please visit the link to the MITS Secure Portal Login.
Please make sure to add or update all practice locations and provider affiliations in advance of data conversion.
On Oct. 1, provider enrollment and maintenance-related activities will resume and be accessed using PNM. For more information visit PNM and trainings.
Registration is open for Provider Network Management (PNM) Training!
As you are likely aware, Ohio Medicaid is in the process of implementing our Next Generation program to focus on the individual rather than the business of managed care so that we can do better for the people we serve. One way we hope to achieve this vision is through the implementation of the Provider Network Management (PNM) module to reduce the administrative burden on providers.
Training and Learning Management System
In preparation for Stage 2 go-live (Oct. 1, 2022), we are offering a variety of training options including self-paced, virtual, and in-person training options. Absorb, the Learning Management System (LMS), is where you will access the self-paced training and sign up for the virtual and/or in-person sessions.
LMS Registration
Training sessions are scheduled to begin Aug. 1, 2022, and it is important that you create an account in the LMS to ensure you have access to all training sessions, answer forms, and PNM resources in advance. Click on the appropriate link below, based on your provider type, to access the LMS and follow the steps to create your account and register for training:
| Provider Group | Enrollment Key |
|---|---|
individualprovider |
|
grouporgprovider |
|
hospitalprovider |
|
facilityprovider |
|
bhindividualprovider |
|
bhorgprovider |
|
doddwaiverprovider |
|
doddnomedprovider |
|
odawaiverprovider |
Questions
Please email ohiotrainingteam@maximus.com with any questions regarding training sessions or additional information.
About the PNM and Centralized Credentialing
The PNM module and Centralized Credentialing program are part of the “Big 5” strategic initiatives being implemented within the Next Generation of Ohio Medicaid’s managed care program.
The PNM will replace the current Medicaid Information Technology System (MITS) provider enrollment subsystem provider portal. This module will be implemented along with Centralized Credentialing, which is a state-level single centralized provider credentialing process. These initiatives will modernize the system by streamlining processes and reducing administrative burdens for providers. For more information about PNM and Centralized Credentialing, visit the Managed Care website.
In preparation for the October 1, 2022, Stage 2 launch of the Next Generation program, the Ohio Department of Medicaid (ODM) is kicking-off its provider awareness and training efforts.
They are hosting 2-hour webinars, customized by provider type, to share information on the exciting changes. Providers can expect, an overview on the transition to the Ohio Medicaid Enterprise System (OMES) modules, upcoming training plans and dates, and how providers can receive communications from ODM throughout the Next Generation transition and implementation.
Please utilize the links below to register for the provider group session that you best fit. We kindly request that providers only join one live event due to capacity limitations.
The webinar is being offered several times and will also be made available as a recording on Resources for Providers webpage of the Ohio Medicaid Next Generation website.
So using the first one as an example, something like "Register for the Physicians, Physician Groups, Podiatrists webinar" would work, or "Register for the webinar on Tuesday, July 19th 3:00pm – 5:00pm ET"
Physicians, Physician Groups, Podiatrists
Register for the webinar on Tuesday, July 19th 3:00pm – 5:00pm ET
Behavioral Health Organizations and Individual BH Practitioners
Register for the webinar on Wednesday, July 20th 1:00pm –3:00pm ET
Hospitals, Ambulatory Surgical Centers, Pharmacies
Register for the webinar on Thursday, July 21st 9:00am – 11:00am ET
DODD, ODA, ODM HCBS Waiver Providers (Independent Providers and Agencies, Assisted Living Providers)
Register for the webinar on Friday, July 22nd 10:00am – 12:00pm ET
Physicians Assistants, Advanced Practice Nurses, Occupational Therapists, Physical Therapists, Dietitians, Audiologists, Speech Language Therapists, Medicaid School Program
Register for the webinar on Monday, July 25th 3:00pm –5:00pm ET
Rural Health, Community Health Centers, General Public Health, FQHC
Register for the webinar on Tuesday, July 26th 9:00am – 11:00am ET
Dentists, Optometrists, Chiropractors (Non-Physician), DPM Professional Degrees)
Register for the webinar on Wednesday, July 27th 1:00pm –3:00pm ET
Long Term Care Facilities (SNF and ICF-IID), Home Health Agencies, Hospice
Register for the webinar on Thursday, July 28th 3:00pm – 5:00pm ET
DME Providers, Transportation Providers, Other Providers
Register for the webinar on Friday, July 29th 10:00am – 12:00pm ET
The Ohio Department of Medicaid (ODM) will begin to launch its Next Generation Medicaid program beginning July 1, 2022, with the implementation of OhioRISE, a coordinated care program for children with complex behavioral health needs. Other Medicaid programs will be implemented in the following months on a staggered basis to keep the focus on the individual and honor member choice to allow for a smooth transition.
This staggered start ensures continuity of care, limits confusion, and reduces complexities surrounding the anticipated end of the federal public health emergency (PHE) and provides the necessary time for provider testing and training.
The phased implementation will occur in three stages:
Stage 1: On July 1, OhioRISE will begin to provide coordination and specialized services to help children and youth with behavioral health needs who receive care across multiple systems.
Stage 2: In October 2022, Centralized Provider Credentialing will begin through the Ohio Medicaid Enterprise System (OMES) Provider Network Management (PNM) module, which will reduce administrative burden on providers. Also, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members.
Stage 3: During the last three months of 2022, ODM will finish implementing the Next Generation program with all seven Next Generation managed care plans beginning to provide healthcare coverage under the new program. ODM will also complete the OMES implementation including the Fiscal Intermediary (FI) which will simplify and streamline the provider process for submitting claims and prior authorizations.
Ohio Medicaid is committed to launching the Next Generation Medicaid correctly. The phased timeline assures no disruption to members’ care or provider support.
For full details of ODM's announcement, visit Ohio Medicaid’s Next Generation program to launch July 1 with OhioRISE | Medicaid
The Ohio Department of Medicaid (ODM) along with the Department of Developmental Disabilities (DODD) and Ohio Department of Aging (ODA) are in the process of implementing a new Provider Network Management (PNM) module and Centralized Credentialing effective July 1, 2022.
In preparation for the rollout of the new system, ODM is expected to implement a freeze period some time in May. During the freeze, ODM will not process or update information on the MITS system as they migrate current information over to the new PNM file.
Once the migration is complete, all Managed Care Plans will be expected to mirror the information in the PNM file. Files will be shared and loaded onto the Buckeye Health Plan system to reflect only the information that is on file through the State of Ohio.
We are asking all providers to update their information on the Provider Master File (PMF) through MITS prior to the anticipated freeze. MITS Provider Directory
For more details regarding the new PNM and centralized credentialing please visit the website link PNM & Centralized Credentialing | Ohio Medicaid Managed Care.
Thank you in advance for taking the time to update all your demographic information.
Slides for Providers Submitting PA and Attachments for MCE's via PNM Portal - Coming Soon
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.
- MITS PROVIDER DIRECTORY
- Centralized Credentialing FAQ
- 10 Things you should know about Centralized Credentialing
- Differences between Enrollment and Credentialing
- Training - The training is expected to begin in May 2022 and additional details will be forthcoming.
- PNM Provider Network Module Centralized Credentialing Template | PowerPoint Presentation (ohio.gov)
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.
- Gainwell Portal
- Ohio Medicaid Single Pharmacy Benefit Manager (SPBM) – Find additional information about the SPBM.
- ODM Email Box – Contact ODM for questions on the SPBM.
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 5160-26 – View managed care plan requirements from the Ohio Administrative Code.
- Ohio Revised Code – Chapter 5167 – 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.
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.