Reminder: Medicaid New Programming Launches Feb. 1
Over the last several months, OSMA has provided information to members related to major program changes to the Ohio Medicaid program starting Feb. 1. Ohio Medicaid has provided a one-page overview document for practices to ensure you’re aware of the changes and what you need to do to prepare. Please take a few minutes to review the document before next Wednesday and reach out to the relevant contacts with any questions.
The Next Generation managed care plans, new Electronic Data Interchange (EDI) module, and Fiscal Intermediary (FI) will be implemented on February 1, 2023.
The Next Generation managed care plan changes and EDI trading partner transactions do not apply to MyCare Ohio plans, which will continue to provide benefits to Ohioans who receive both Medicaid and Medicare benefits, with enhanced coordination of medical, behavioral, and long-term care services.
- What’s changing February 1? Learn about the Next Generation program and the initiatives that have been and will be launched, by reviewing the Next Generation Ohio Medicaid Program Overview document.
- Where to get answers for common questions? The Ohio Medicaid Managed Care Member frequently asked question (FAQ) document and Ohio Medicaid Managed Care Plan Provider FAQ will answer questions related to the implementation of the Next Generation plans for both members and providers.
Where to go for PROVIDER assistance
Ohio Medicaid providers can reach out to the help desk listed below or review the February 1 Ohio Medicaid Provider Help Desk One-Pager.
- Questions related to Ohio Medicaid Enterprise System (OMES) submitted claims or prior authorizations, or other administrative tasks, should be directed to the ODM Integrated Help Desk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov.
Provider Network Management module refresher training
Absorb, the learning management system (LMS), is where the self-paced and virtual training sessions are accessed. If you do not have an account in the LMS, it’s important that you create one to ensure you can access all training sessions, answer forms, and view a variety of Provider Network Management (PNM) module resources. Access the job aid and follow the steps to create your account and register for training.
The training schedule has been posted and is available on the Next Generation website. Training module topics include:
- Agent setup and assignment.
- Adding/editing/confirming affiliations.
- Completing an update.
- Explanation of why enrollment actions do not display.
- Explanation of current statuses in the PNM module.
- Medicaid Information Technology Systems (MITS) redirection/issues.
- PNM helpful tips.
- Cost reports and rate setting.
- Accessing remittance advice.
Electronic Data Interchange (EDI) module:
8 things you need to know to prepare
On Feb. 1, ODM will implement the new Electronic Date Interchange (EDI) module as part of the Next Generation program. ODM has released a fact sheet with the top eight things you need to know.
For more information:
To learn more about the PNM module and Centralized Credentialing, visit the PNM and Centralized Credentialing page on the Next Generation website. If you are experiencing any technical issues accessing the PNM module or have specific questions, please contact Medicaid’s Integrated Help Desk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. The IHD is open Monday - Friday, 8 a.m.- 4:30 p.m. Eastern time.