Become A Medicaid Provider Ohio

Date:

Unitedhealthcare Dual Complete Plans

Become An Ohio Medicaid Provider

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Uhc Community Plan Of Ohio Uses Medical Service Company For Respiratory Supplies

Ohio Medicaid members must order respiratory supplies from one vendor. The vendor is Medical Service Company. To get supplies contact the Medical Service Company team:

Medical Service Company Dedicated Intake Team

Hours from 8:30 am to 5:00 pm Monday – Friday

  • Email:

Note: Ohio Medicare Dual SNP and MyCare are excluded. Members under the age of 7 are excluded. Please use the online directory to find a supplier.

Provider Enrollment And Certification

To participate in the Health Partnership Program and to be eligible for reimbursement, medical providers must become BWC-certified.

Complete and submit the Application for Provider Enrollment and Certification along with all other required documentation. We will review the information to ensure you meet the minimum certification criteria as defined in OAC 4123-6-02.2. Providers must meet all licensing, certification and accreditation requirements necessary to provide services. Other minimum credentials are based on provider type. If you meet all the credentialing criteria and sign the provider agreement of the application, we’ll certify you.

Enrolled, non-certified providers

Not all providers are eligible to become certified. These are generally not medical providers but business or vocational plan service providers. They must complete the Application for Provider Enrollment-Non-Certification .

Note: Provider group practices enroll with this application. All BWC-certified providers, along with group practices, are listed in our Provider look-up.

If you have additional questions not covered here, call , and listen to the options

Resources

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What Benefits Are Coming With Pnm

There are several new features and enhancements in the PNM that are designed to streamline processes and reduce administrative burdens for providers.

  • Gives providers the ability to view specialties and effective dates.
  • Provider change or update requests submitted in the PNM can also be reviewed and accepted within the PNM. There is no need for email or letters.
  • Provides a comprehensive provider directory at the state level.
  • Providers may opt in or out to text message notification options for providers.
  • No more paper agreements for long term care facilities all agreements are available online and do not require mailing back and forth for signatures.

About Ohio Medicaid’s Next Generation Program

2020 OH Medicaid Guide: Income Limits, Exempt Assets, Long Term Care

In 2019, the Ohio Department of Medicaid launched a series of procurements and strategic initiatives with the goal of creating a Next Generation managed care program focused on the individual. This focus supports us in doing better for the people we serve and the providers who are our partners.

The Next Generation of Ohio Medicaid program will be implemented in stages to avoid unnecessary disruption and confusion for members and to reduce burdens on our service providers. The Next Generation program will be implemented in the following stages:

Stage 1: On July 1, 2022, OhioRISE will begin providing specialized services, which will help children and youth with behavioral health needs and help coordinate care for those who receive care across multiple systems.

Stage 2: On October 1, 2022, Centralized Provider Credentialing will begin which will reduce administrative burden on providers. Also, the Single Pharmacy Benefit Manager will begin providing pharmacy services across all managed care plans and members.

Stage 3: On December 1, 2022, the implementation of the Next Generation managed care plans will occur. Members will experience benefits that help address their individual health care needs such as increased access to care coordination and care management supports. Also in stage three,ODM willimplementadditional improvements to streamline the process of claims and prior authorization submission for providers.

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Credentialing Process On Or After July 1 2022

The Ohio Department of Medicaid is responsible for credentialing all Medicaid Managed Care providers. The credentialing and recredentialing processes are paired with enrollment and revalidation, respectively, in the Provider Network Management system. This process adheres to National Committee for Quality Assurance and Centers for Medicare & Medicaid Services federal guidelines for both processes and the types of providers who are subject to the credentialing process.

Please note, you are not able to render services to Medicaid members until you are fully screened, enrolled, and credentialed by Ohio Medicaid. For a complete list of provider types that require credentialing, please refer to

Humana is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. . Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state.

Medical Plans

Go365® is not an insurance product. Not available with all Humana health plans.

Individual Dental and Vision Plans

In states, and for products where applicable, the premium may include a $1 administrative fee. If you have purchased an association plan, an association fee may also apply. Some plans may also charge a one-time, non-refundable enrollment fee. .

Group Dental and Vision Plans

Life Insurance Plans

Become A Medicare Provider Or Supplier

Ready to become a Medicare provider or supplier? This guide will help you enroll in three steps.

Do not use this guide if

Use this guide if any of the following apply:

  • Youre a health care provider who wants to bill Medicare for your services and also have the ability to order and certify.
  • You dont want to bill Medicare for your services, but you do want enroll in Medicare solely to order and certify.
  • You wish to provide services to beneficiaries but do not want to bill Medicare for your services.
  • You want to enroll as a supplier who does not dispense or furnish durable medical equipment, prosthetics, orthotics and supplies .

Step 1: Get an NPI

If you already have an NPI, skip this step and proceed to Step 2.

NPIs are issued through the National Plan & Provider Enumeration System . You can apply for an NPI on the NPPES website. Not sure if you have an NPI? Search the NPI Registry.

Keep Your Information Current

Its important to keep your enrollment information up to date. To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days:

  • a change in ownership

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Prior Authorization And Notification Resources

  • Ohio Department of Medicaid Emergency Provider Agreement Changes
  • The ODM Provider FAQs has specific information on Ohios changes:
  • Prior authorization requirements resume for services rendered July 1, 2020 and later. Providers must submit prior authorization requests in accordance with UnitedHealthcare policies and procedures.
  • Timely filing for claims extended to 365 calendar days from the date of service.
  • Access to telehealth services is expanded.
  • For the pharmacy benefit, there are changes to prescription guidance, refill limits and prior authorization requirements.

Monday-Friday, 8 a.m. 5 p.m.

Postal Mailing Address

9200 Worthington Road, 3rd FloorWesterville, OH 43082

Attn: Complaint and Appeals DepartmentP.O. Box 31364Salt Lake City, UT 84131Fax: 994-1082

Attn: Complaint and Appeals DepartmentP.O. Box 31364Salt Lake City, UT 84131Fax: 994-1082

UHC Connected For MyCare Ohio Appeals Mailing Address

Part C Appeals or Grievances:UnitedHealthcare Community PlanAttn: Complaint and Appeals DepartmentP.O. Box 31364Salt Lake City, UT 84131Fax: 994-1082

Attn: Complaint and Appeals DepartmentP.O. Box 31364Salt Lake City, UT 84131Fax: 994-1082

Attn: Part D Standard AppealsP.O. Box 6103

For Credentialing and Attestation updates, contact the National Credentialing Center at 1-877-842-3210.

Need to make a change to your provider or facility directory information?

Behavioral Health Providers

The Centers for Medicare & Medicaid Services established the Medicaid Managed Care Rule to:

Important Update: Changes In The Provider Application Process

Become a Medicaid Waiver Provider of RN, LPN, NP or Licensed Professional Services

Effective July 22, 2022, the Ohio Department of Aging has suspended the application process for PASSPORT and Assisted Living waiver applicants.

Providers who were in the process of applying but did not submit a complete application by July 22, 2022 will have to reapply in October 2022 when the new application system is in place .

What is PNM?

The Ohio Department of Medicaid is introducing a Provider Network Module , a single point of entry provider portal giving providers one front door to manage enrollment administration. The PNM module streamlines the enrollment and revalidation processes and simplifies the user experience.

When will PNM be implemented?

ODM will roll out the new PNM system for all new and existing Ohio Medicaid Providers this fall. In the coming weeks ODM will share insight into the change, provide timelines, resources, and instructions for PNM through email notifications to providers and stakeholders of the upcoming PNM implementation plan.

How does PNM impact new ODA provider applicants after the PNM go-live date?

Instead of an ODA provider starting at the ODA electronic application system, the Provider Certification Wizard , the providers will now sign in through the PNM portal, select which state agency they want to apply: ODA, DODD, or ODM. Based on the providers selection, the provider will be redirected to the appropriate agencys system to complete the application process.

Provider questions?

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Referrals From Your Pcp

Your PCP can handle most routine health care needs. If you need to see a network specialist or other network provider, you may need to get a referral from your PCP. Your PCP will make a referral based on your health situation. They may or may not refer you to a particular specialist in this directory who you want to see. Generally, your PCP will provide follow-up care, as needed. Please see the Evidence of Coverage for information about access to specialists. This directory provides a list of skilled nursing facilities for all networks. Contact your PCP for a referral to a network skilled nursing facility. The “network providers” listed in this directory have agreed to provide you with your health care coverage. However, some services may require a referral. If you have been going to one network provider, you are not required to continue going to that same provider. Check your Evidence of Coverage to make sure your plan includes additional benefits or that you’ve signed up for optional supplemental riders before making appointments for dental, vision or hearing services.

If you dont have your copy of the Provider Directory, you can request a copy from Customer Service.

Start The Contracting Process

Fill out the New Health Partner Contract Form to get started.

If you offer medical services and want more information about becoming a participating provider, please submit the New Health Partner Contract Form.


  • Your Application Status

    Once you submit your application, you will receive a confirmation email. Please save this email, as it will contain your Application ID.

    You can check your application status on the Provider Portal. You will need to enter your NPI and Application ID to view your status.

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What Is Centralized Credentialing And What Benefits Will It Provide

ODM is implementing a single, centralized provider credentialing process at the state level with the go-live of the PNM portal. There are many expected benefits of this centralized approach, including:

  • Providers subject to credentialing will only undergo one credentialing and recredentialing process at the state level vs. a separate additional process for each Ohio Medicaid managed care organization .
  • A Credentialing Verification Organization Maximus, Inc. will maintain NCQA accreditation requirements for Ohios MCOs and serve as ODMs single point of contact for providers as they undergo credentialing and recredentialing reviews.

Centralized Credentialing Summary

Join Us For The Next Generation Ohio Medicaid Program Provider Overview Webinar

Choose Buckeye

We are excited to share that the Ohio Department of Medicaid is kicking off its provider awareness and training efforts in preparation for the October 1, 2022, Stage 2 launch of the Next Generation program! To begin these efforts, we will be hosting a 2-hour webinar to share information on the exciting changes Ohio Medicaid providers can expect, including an overview on the transition to the Ohio Medicaid Enterprise System modules, upcoming training plans and dates, and where providers can receive communications from ODM throughout the Next Generation transition and implementation.

The webinar is being offered several times and will also be made available as a recording on this page. We kindly request that you only join one live event due to capacity limitations.

Provider Group

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Start With Background Check

An application packet will not be ready for review until all supporting documents, including background checks, are submitted.

Background checks are submitted directly to DODD from the Ohio Attorney Generals Office.

To start the background check, visit a WebCheck location.

The results of a background check can take up to 45 days to be completed and sent to DODD.

Unitedhealthcare Connected General Benefit Disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

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I Would Like To Select My Plan

To make a Next Generation plan selection, Ohio Medicaid members can use the Ohio Medicaid Consumer Hotline Portal by clicking on the Select a Plan Online option below or by contacting the Ohio Medicaid Consumer Hotline at 324-8680.

Other Ways to Change your Health Plan

If you are unable to change health plans online at this time, there are several other options available to you.

New Services Are Being Added To Ohio Home Care Waiver

How do I become a Medicaid Provider?

Effective July 1, 2019, three new home and community-based services will be available to individuals enrolled on the Ohio Home Care Waiver. The new services are Community Integration, Community Transition and Home Maintenance/Chore. To find out more about the services and determine if or how you can become a provider. .

Also Check: What Is The Best Medicaid Plan In Michigan

American Disabilities Act Notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Unitedhealthcare Senior Care Options Plan

UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

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Unitedhealthcare Community Plan How To Enroll

Information on eligibility and enrollment can be found by visiting the Ohio Medicaid website or by calling the Medicaid Hotline at . TTY users should call Ohio Relay at 7-1-1.

If you are already eligible for Ohio Medicaid and would like to enroll with UnitedHealthcare Community Plan, please call the Managed Care Enrollment Center at .

Already a member and need to renew your Medicaid eligibility?

It is important to keep your Medicaid eligibility current to keep your UnitedHealthcare Community Plan benefits. Contact your local County Department of Job and Family Services to renew your eligibility.

OhioRISE

Who is eligible to enroll into OhioRISE?

You must be:

  • Under the age of 21.
  • Determined eligible for Ohio Medicaid.
  • Not be enrolled in a MyCare Ohio plan.
  • Have one of the following:
  • Certain needs for behavioral healthcare, identified by the Ohio Childrens Initiative Child and Adolescent Needs and Strengths assessment
  • Have a recent inpatient hospital stay for mental illness or substance use disorder
  • Have a recent inpatient stay in a Psychiatric Treatment Facility
  • What is OhioRISEs rolling enrollment policy?

    For more information, please visit:

    What is the process for referring children/families for a CANS assessment?

    To ask for a CANS assessment, contact:

    What is the timeline for a CANS assessment and OhioRISE determination?

    To contact us, you can:

    c/o OhioRISE Plan

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