Paramount Medicaid Ohio Phone Number

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New Paramount Advantage Claims System Update

Paramount would like extend a sincere THANK YOU to all of our providers for your patience and feedback as weve migrated the Advantage product line with dates of service on or after June 1, 2021, to our new claims processing system.

A couple of updates we wanted to share with you:

  • The Paramount Provider portal is now fully functional for all dates of service
    • This includes claim status lookup, eligibility, EOP access and authorization status
  • Beginning Wednesday, Sept. 15, 2021, Paramount will be temporarily expanding our Provider Inquiry call center hours.
    • We have also instituted a save your place in line feature on our phone lines
  • Vpay now has a provider portal for access to view payments and EOPs as well on the Paramount Provider portal
    • Please contact Vpay directly for more information at
  • Medicaid Member IDs should always contain 11 characters:
    • Dates of Service Prior to 6/1/21 – A00XXXXXX01
    • Dates of Service On or After to 6/1/21 – 100XXXXXX01

As always we appreciate the care you provide for our members each and every day. If you have any questions or need assistance with the portal please reach out to your Provider Relations representative or email .

Paramount Advantage Is Here For You

Our new normal may be anything but ordinary, and you may feel like things havent gone according to plan this year. However, helping you stay healthy is still our everyday mission. When you feel like you dont have a plan, we do! Isnt it time for a little advantage?

Please call Paramount Elite between 8:00 a.m. and 8:00 p.m. Monday through Friday. From October 1 to March 31, we are available 8:00 a.m. to 8:00 p.m. seven days per week.

Existing Members – Member Services

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Care Management And Coordination

  • Update the health risk assessment requirement for all members and require it for all new members within 90 calendar days of enrollment.
  • Strengthen collaboration requirements related to care coordination for children in custody, per the Ohio Department of Medicaids guidance for children in custody.
  • Update quality improvement program language to emphasize disparity reduction and health equity efforts, with an emphasis on health equity as the utmost goal of the quality strategy.
  • Add coordination language for medication-assisted treatment and pre-release enrollment program participants through collaboration and communication with the Ohio Department of Rehabilitation and Corrections, Ohio Department of Mental Health and Addiction Services, and community providers.
  • Add responsibilities related to addiction treatment program drug courts.
  • Add requirements for MCOs to use level of care and ODMs prior authorization form for nursing facility stays. MCOs are required to accept the form if properly submitted by a nursing facility.
  • Clarify and strengthen language regarding inpatient hospital readmissions.
  • Revise third party payer requirements.

Why Choose Paramount Advantage

Paramount Health Care

We offer our members and their families the following benefits at no cost:

  • Exceptional customer service: Speak to the same rep every time. Someone who really understands your story.
  • Medical coverage: Access many local doctors, hospitals, dentists and pharmacies.
  • Additional coverage: Prescriptions, dental cleanings, new glasses, flu shots and immunizations are all covered.
  • Transportation assistance: Get rides and reimbursement for trips to and from medical and wellness appointments, the pharmacy, WIC and more.
  • Rewards: Get rewarded just for going to routine appointments like wellness visits and prenatal/postnatal checkups.
  • 24/7 Nurse Line: Paramount has a team of nurses available to answer your medical questions 24/7.
  • Online doctor visits: We offer convenient video visits with a provider through our ProMedica OnDemand service.

Also Check: Medicaid Healthy Connections Phone Number

Who To Call At Paramount

The team at Paramount Advantage Medicaid stands ready to answer your questions and provide the information you need to care for your patients and our members! Here are a few of the things that we would be happy to help you with

  • CREDENTIALING
  • All member questions and grievances
  • Primary care provider change requests
  • Interpreter services
  • Provider and office staff education
  • Contract issues
  • Obtaining in-plan and out-of-plan prior authorizations
  • Case and care management
  • Obtaining drug prior authorizations

Any reference obtained from this server to a specific product, process, or service does not constitute or imply an endorsement by the Ohio Association of Community Health Centers of the product, process, or service, or its producer or provider. The views and opinions expressed in any referenced document do not necessarily state or reflect those of the Ohio Association of Community Health Centers.

Health Care With Heart

There is a reason more Ohioans choose CareSource for their Medicaid plan than all other plans combined. Its because CareSource is more than just quality health care. We care about you and your familys health and wellbeing. CareSource members get access to a large provider network, reward programs like Kids First and Babies First®, free rides to health care appointments, pharmacies and more. Plus, we never charge a copay for any medical or behavioral health service!

Choose CareSource for your Ohio Medicaid health care plan and join over 1.2 million members who trust us with their health and well-being.

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Request For Information #1

Paramount Advantage Ohio Medicaid Single Mom Cleveland

In early 2019, Ohio Governor Mike DeWine called on the Ohio Department of Medicaid to ensure Ohioans get the best value in providing quality care. To inform the process, we launched our first RFI to collect feedback and suggestions from individuals who receive services through managed care, providers, advocacy groups, and community-based organizations.

Our mission in this process is to focus on the individual rather than on the business of managed care, said Governor DeWine. The request for feedback released today seeks information specifically from individuals receiving Medicaid services, providers and advocates. Their voices are vital to a just and fair managed care program.

The public responses to RFI #1 are available on the RFI #1 Responses page at medicaid.ohio.gov.

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Previous Procurement Phases: Requests For Information

Beginning in June 2019, the procurement process focused on collecting feedback and suggestions for improving the program from individuals who receive services through managed care, providers, advocacy groups and community-based organizations through two RFIs. Through this effort, Ohio Medicaid received more than 1,000 suggestions and pieces of feedback, which informed the development of RFAs, Requests for Proposals and provider agreements to support the next generation of Ohios Medicaid managed care program.

Additional details on these RFIs can be found in the drop-downs below.

Paramount Advantage To Exit Ohio Medicaid Managed Care Program In Central/southeast Region

LASCIn The News

Paramount has decided to scale back the service area of its Medicaid plan. The insurance company will cease to provide Paramount Advantage Medicaid in the central/southeast region of Ohio. It will continue to serve the west and northeast regions.

The central/southeast region includes these counties: Athens, Belmont, Coshocton, Crawford, Delaware, Fairfield, Fayette, Franklin, Gallia, Guernsey, Harrison, Hocking, Jackson, Jefferson, Knox, Lawrence, Licking, Logan, Madison, Marion, Meigs, Monroe, Morgan, Morrow, Muskingum, Noble, Perry, Pickaway, Pike, Ross, Scioto, Union, Vinton and Washington.

For Paramount Medicaid members in the central/southeast region, they will choose a new Medicaid managed care plan for their health insurance in the next few months. Paramount will work closely with members and the Ohio Department of Medicaid to make sure members move seamlessly to their new plans in a way that is least disruptive for both members and providers. We are committed to keeping both members and providers informed through this several month transition.

For Paramount Medicaid members in the west and northeast regions,nothing will change. These members will continue to be members of the Paramount Medicaid managed care plan with the same health insurance benefits.

Paramount Medicaid Providers will remain contracted with Paramount and continue to be eligible to see Paramount members regardless of where the member lives.

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Where Do I Get Started

We know that it can be stressful to navigate the insurance coverage process, but we strive to make it as smooth as possible.

We accept a variety of plans from insurance companies at all of our locations. To verify if your insurance plan is accepted for services across our health system, please review our list of accepted insurance companies below.

If your insurance company is accepted by Cleveland Clinic: Please contact your insurance company to confirm what care is covered by your plan as well as information on copayments, deductibles and coinsurance amounts. See what your out-of-pocket expenses will be using our cost estimator.

If your insurance company is not accepted by Cleveland Clinic: This means your insurance plan is considered out-of-network which can lead to greater out-of-pocket expenses for your care. Please contact your insurance company for more information about what your financial responsibility may be if you choose to receive care at Cleveland Clinic. Find more information about Cleveland Clinics out-of-network insurance process.

Medicaid Managed Care Annual Open Enrollment

Choosing an Ohio Medicaid Managed Care Plan

Beginning September 17, 2021, Ohio Medicaid managed care members will be able to select their plan by calling the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or utilizing the Ohio Medicaid Consumer Hotline Member Portal. You do not have to do anything if you want to keep your current Medicaid Managed Care Plan.

Visit the Ohio Medicaid Consumer Hotline website for information.

Questions about CareSource?

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Is My Virtual Visit Covered By Insurance

Cleveland Clinic provides virtual visits for your convenience and health. Virtual visits are not covered by all insurance plans. In order to fully understand your benefits and potential cost, contact your insurance company and ask if virtual visits are included in your plan and if not, what it may cost you.

Request For Information #2

The feedback gathered through RFI #1 informed development of RFI #2, which outlined our vision for the next generation of Ohios managed care program. This second RFI sought input from providers, associations, advocacy groups, data and information technology vendors, and managed care organizations. ODM received nearly 100 responses to RFI #2. The RFI #2 response period closed on March 3, 2020.

RFI #2 was a continuation of the process initiated by Governor DeWine to implement some of the most innovative health care reforms in the country. It examined the current health care experience of nearly 3 million Ohio Medicaid consumers and offered ideas to reduce barriers, streamline access, and enhance health care delivery. The public responses to RFI #2 are available on the RFI #2 Responses page at medicaid.ohio.gov.

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Which Insurance Plans Are Accepted At Cleveland Clinic

Below is the list of plans that are accepted at Cleveland Clinic main campus, our family health centers and community hospitals in Northeast Ohio.

The list below is for reference purposes only and is subject to change. Not all plans within the companies listed are considered participating. Always check with your health plan to confirm that Cleveland Clinic is included.

The Next Generation Of Managed Care

Paramount Advantage Ohio Medicaid Single Mom Toledo

Ohio Medicaid delivers health care coverage to more than 3 million Ohio residents. Of those, more than 90% receive coverage through one of five MCOs – Buckeye Health Plan, CareSource, Molina Healthcare, Paramount Advantage, or UnitedHealthCare Community Plan. Because managed care impacts such a large number of Ohioans, Ohio Medicaid has done a top-to-bottom review. Ohio Medicaid has embarked on a next generation managed care approach to align with todays expectations for the future of health care.

Throughout 2021, Ohio Medicaid will work with incoming MCO to prepare for the beginning of services under the new program in January 2022. The hallmarks of Ohio’s next generation Medicaid managed care program include:

  • Improving wellness and health outcomes through a unified approach to population health that includes a new emphasis on defined principles to address health inequities and disparities.
  • Emphasizing a personalized care experience through a seamless delivery system for members, providers, and system partners.
  • Supporting providers in better patient care by reducing administrative burdens and promoting consistency.
  • A centralized credentialing system eliminates the need to perform a unique credentialing process with each MCO.
  • The fiscal intermediary serves as a central clearinghouse for provider claims and prior authorization requests.

Each of these goals is also supported through the procurement of and transition to new MCO contracts.

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Medicaid Managed Care Procurement Award

On April 9, 2021, ODM announced the selection of six managed care plans to lead the departments evolution of managed care services for its more than 3 million members and thousands of medical providers. Additional information about the announcement can be found in the press release and supplemental briefing document.

Current Phase of the Ohio Medicaid Managed Care Request for Applications

The selection reflects the results of intensive stakeholder engagement efforts to define opportunities to strengthen the structure of Ohios $20 billion managed care program. It addresses Governor Mike DeWines direction at the beginning of his term to re-evaluate Ohios managed care system with the goal of making the system more focused on individuals.

The seven MCOs selected for the next generation managed care program are:

ODM is projecting that beginning July 1, 2022, Ohio Medicaid managed care members will begin receiving services from one of the seven next generation managed care plans. This timeline allows ODM to go-live with a next generation program that is focused on the individual and provides members increased choice and ability to select a plan that fits their individual needs. This also takes the complexity of the systems and operational changes being made into consideration to provide ODM with time to conduct significant training to support providers in utilizing new systems. View the press release here.

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Paramount Advantage Service Area Changes

Paramount Advantage Medicaid has made the hard decision to no longer be part of the Ohio Medicaid Managed Care Program in the central/southeast region.

The central/southeast region includes these Ohio counties: Athens, Belmont, Coshocton, Crawford, Delaware, Fairfield, Fayette, Franklin , Gallia, Guernsey, Harrison, Hocking, Jackson, Jefferson, Knox, Lawrence, Licking, Logan, Madison, Marion, Meigs, Monroe, Morgan, Morrow, Muskingum, Noble, Perry, Pickaway, Pike, Ross, Scioto, Union, Vinton and Washington.

If you live in the central/southeast region, you will need to choose a new Medicaid managed care plan for your health insurance by June 1. But, know: You are not losing your benefits. You will never be without coverage . Until you move to a new plan, you will continue to be a member of Paramount Advantage Medicaid and use your Paramount health insurance like you have been. This also means that you can continue to see your current providers during the transition period.

During this change, we will work closely with you and the Ohio Department of Medicaid to make sure your switch to a new plan goes well. Over the coming weeks, watch your mail for information on how and when to pick a new plan. However, you do not need to wait until you receive additional information and are permitted and encouraged to select a new plan any time prior to June 1 by contacting Ohio Medicaid Consumer Hotline at 1-800-324-8680.

At Western Lake Erie Oms Ltd

Phyllis J. Polas, DO

We make every effort to provide you with the finest care and the most convenient financial options. To accomplish this we work hand-in-hand with you to maximize your insurance reimbursement for covered procedures. If you have any problems or questions, please ask our staff. They are well informed and up-to-date.

West Toledo office staff can be contacted by phone at 479-3939.

East Toledo office staff can be contacted by phone at 691-5226.

Monroe MI office staff can be contacted by phone at 243-9160.

Please call if you have any questions or concerns regarding your initial visit.

Please bring your dental and medical insurance information with you to the consultation so that we can expedite reimbursement. Here is a list of some of the insurances we accept.

PLEASE CALL YOUR INSURANCE TO VERIFY THAT WE ARE IN NETWORK. NOT ALL OF OUR SURGEONS ARE CREDENTIALLED WITH ALL OF THE INSURANCE COMPANIES. HERE IS A LIST OF SOME OF THE INSURANCES WE CURRENTLY ACCEPT IN THE OHIO OFFICES:

Dental Insurances Accepted

Blue Dental, CGS Medicare, Cigna, Connections Dental, Aetna Dental PPO, Delta Dental . Delta Dental PPO . Delta Dental Premier, Dentemax, Guardian, MetLife Preferred Dentist Program, Superior Dental Care, Ohio Medicaid, Envolve , Dentaquest , Paramount Advantage, Other Dentaquest plans Ohio BCMH, Ohio Workers Compensation

Medical Insurances Accepted

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