08/18/2022

Preparing for Ohio Department of Medicaid Next Generation of Managed Care

The PNM Pre-Registration Tool is Live!

The Provider Network Management (PNM) Pre-Registration tool is available from Aug. 15 until Sept. 23 and will ease the transition and prevent disruptions to system access for providers ahead of go-live on Oct. 1.

How do I access the PNM Pre-Registration tool?

Please visit https://pnm-preregistration.omes.maximus.com to access the PNM Pre-Registration 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:

1. Go to myohio.gov
2. Fill in the appropriate fields with user information and create account.
3. An email confirmation will be sent following registration.
4. 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 that OH|ID account log in is required to access this site)

New OhioRISE Provider Enrollment Guidance is Effective Aug. 1 – Sept. 30, 2022

In recognition of the ongoing enrollment of OhioRISE members and the needs to support and build the system of care related to the July 1 launch of the OhioRISE program, ODM and Aetna Better Health of Ohio (Aetna) partnered to develop a process for OhioRISE provider enrollment during this time. Organizational or individual practitioners who will be providing OhioRISE services can be screened for enrollment so that they can provide and bill for services. A new process for enrolled Medicaid providers who wish to add OhioRISE provider specialties during the provider enrollment system downtime is also in place.

Where can I learn more about the new process?

On July 29, ODM released OhioRISE Provider Enrollment During System Downtime Guidance available on the Resources for Community Partners and Providers page of the OhioRISE webpage. You will find detailed information regarding the steps you should take to enroll as a Medicaid provider or enroll in OhioRISE provider specialties between Aug. 1 and Sept. 30.

Where can I direct my questions?

If you have questions about Ohio Medicaid provider enrollment, please contact ODM’s Integrated Help Desk (IHD) at 800-686-1516, which is available Monday through Friday 8 a.m.-4:30 p.m. For Aetna/OhioRISE plan contracting questions, please contact Aetna’s OhioRISE Provider Experience Help Line at 833-711-0773 (option 2), which is available Monday through Friday 7 a.m.-8 p.m.

The Next Generation Health Plan Comparison is Now Available!

Beginning Dec. 1, 2022, the Next Generation managed care plans will provide Ohio Medicaid managed care members more personalized healthcare benefits, such as increased access to care coordination and care management supports, that will help address their individual healthcare needs.  

To assist Ohio Medicaid managed care members in choosing which Next Generation plan is the best fit for their healthcare needs, the Ohio Department of Medicaid has introduced the Next Generation Health Plan Comparison document. The Next Generation Health Plan Comparison document provides an overview of the services that all Next Generation managed care plans provide, and specific value-added services provided by each individual plan. 

All Ohio Medicaid managed care members can select a Next Generation plan at any time through Nov. 30.  

Have additional questions about what actions Ohio Medicaid managed care members are encouraged to take? Visit www.ohiomh.com, or read on for answers to some of the most common questions.    

Will Ohio Medicaid managed care members lose coverage?  

In the coming months, Ohio Medicaid members will receive many communications about their healthcare coverage. It is incredibly important for you to ensure your contact information is up to date. Please carefully review all communications shared by ODM and follow the instructions provided to ensure continuity of coverage. Learn more here.  

What actions are Ohio Medicaid managed care members encouraged to take to select a plan? 

Ohio Medicaid encourages all managed care members to review and select the Next Generation plan that best fits their healthcare needs.  

Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment ending Nov. 30. 

What does this mean for current Ohio Medicaid managed care members who are also enrolled in the OhioRISE program? 

OhioRISE enrollees will receive their behavioral health benefits through Aetna (the OhioRISE plan) and their physical health services through a separate managed care organization or fee-for-service Medicaid. 

What does this mean for current Ohio Medicaid managed care members currently with Paramount Advantage? 

Current Ohio Medicaid managed care members who do not select a plan will stay with their current plan, with the exception of Paramount members. Paramount Advantage Medicaid has been acquired by Anthem Blue Cross and Blue Shield (Anthem). Anthem is working with Paramount Advantage to continue providing your healthcare coverage and you will continue receiving healthcare coverage through Paramount Advantage until the Next Generation managed care plans begin providing healthcare coverage. At that time Anthem will be your Next Generation managed care plan. You do not need to take any action to begin receiving healthcare benefits through Anthem and there will be no disruption in your care. All Ohio Medicaid managed care members can select a different plan at any time until the end of open enrollment through Nov. 30. 

What does this mean for Ohio Medicaid managed care members in a continuing plan? 

Ohio Medicaid members do not need to do anything and will remain with their current managed care plan. Ohio Medicaid encourages all members to review the Next Generation plans available and select the plan that best meets their healthcare needs. Members can review and select the Next Generation plan that best fits their healthcare needs at any time through Nov. 30. 

What does this mean for newly eligible Ohio Medicaid managed care members? 

Individuals who are newly eligible for managed care, those who are currently in Medicaid fee-for-service not enrolled with a managed care plan, and those with a gap in eligibility of 91+ days will receive care paid for through Medicaid fee-for-service until Dec. 1 when they will be transitioned to an Ohio Medicaid Next Generation plan. 

ODM will notify impacted members which plan they have been transitioned to. Members can review and select the Next Generation plan that best fits their healthcare needs at any time through open enrollment through Nov. 30. Newborns and case additions will continue to be added to managed care plans as they become Medicaid eligible during this time. 

How can an Ohio Medicaid managed care member select a Next Generation plan?  

Managed care members can review their options using information in communications distributed by Ohio Medicaid and housed on the Medicaid Consumer website at www.ohiomh.com.  Managed care members may select their plan at any time through Nov. 30, by contacting the Ohio Medicaid Consumer Hotline at 800-324-8680 or through the online portal at www.members.ohiomh.com. 

What resources are available to Ohio Medicaid managed care members to help them identify which Next Generation plan best meets their healthcare needs? 

• The Next Generation Health Plan Comparison document provides an overview of the services that all Next Generation managed care plans provide, and specific value-added services provided by each individual plan. The Health Plan Comparison is available on Medicaid Consumer website at www.ohiomh.com.  
• The Find A Provider search tool can help members identify which Next Generation managed care plans their trusted providers are contracted – or “in network” – with.   
• Each Next Generation managed care organization (MCO) has a member website that members can visit to learn more about that MCO’s Next Generation of Ohio Medicaid plan and their approach to serving Ohio Medicaid managed care members:  
• AmeriHealth Caritas Ohio, Inc.
• Anthem Blue Cross and Blue Shield
• Buckeye Community Health Plan
• CareSource Ohio, Inc.
• Humana Healthy Horizons in Ohio
• Molina Healthcare of Ohio, Inc.
• UnitedHealthcare Community Plan of Ohio, Inc.
• Members can call the Medicaid Consumer Hotline at 800-324-8680 if they have additional questions about the Next Generation managed care plan options available.

When will Ohio Medicaid managed care members begin receiving services from their selected plan? 

Ohio Medicaid managed care members will remain with their current managed care plan until Ohio Medicaid's Next Generation managed care plans begin providing healthcare coverage on Dec. 1.