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Cervical Health Awareness Month |
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Next Generation February 1 Launch - Provider Webinar
Thursday, January 19, 3:00 p.m. - 4:00 p.m.
The Ohio Department of Medicaid (ODM) will be hosting a 1-hour webinar to share information on the exciting changes Ohio Medicaid providers can expect, including an overview of the transition to the Next Generation managed care plans, Electronic Data Interchange, and Fiscal Intermediary. Additionally, they will discuss key changes and the resources available to assist providers in the transition. Click here to register.
The webinar will also be made available as a recording on the Resources for Providers webpage of the Ohio Medicaid Next Generation website.
Want to learn more about the benefits Ohio Medicaid providers will experience through the Next Generation February 1 launch? Check out the Resources for Providers webpage.
For questions, please contact ODMNextGen@medicaid.ohio.gov.
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Electronic Data Interchange (EDI) and the Fiscal Intermediary (FI) go live on February 1
What can providers expect on February 1?
Of the February 1 launch, the new EDI and FI will impact providers the most. As we phase in these new system components, some of your day-to-day processes will change while some will remain the same. Read on to understand how you will be affected.
Claims and prior authorization (PA) submitted through trading partner
- ODM’s new EDI begins accepting trading partner fee-for-service (FFS) and managed care claims.
- Provider claims submitted to trading partners must include the Medicaid member ID (MMIS).
- Medicaid ID should be obtained with each encounter.
- Member eligibility can be verified using the ID through the Provider Network Management (PNM) module, which redirects to MITS.
- For professional claims, only one rendering provider is allowed per claim. Individual claims must be submitted for services rendered by different providers. Exceptions for FFS Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) providers are detailed in the Medicaid Advisory Letter 622.
What is not changing February 1?
- FFS PAs will continue to be submitted to the PNM module.
- Managed care PAs will continue to be submitted to each plan using their existing processes.
- The new EDI will not accept PAs of any kind.
Portal submitted claims and all prior authorizations
What are the key changes on February 1?
- All Next Generation plans will have portals for direct data entry.
- MMIS ID will be the identifying number used for FFS claims processing.
What is not changing February 1?
- Continue using managed care plan portals to direct data enter claims and PAs.
- Plan eligibility will continue to be accessed through MCO portals.
- Continue using the PNM module, which redirects to MITS, as you do today to submit, adjust, and search FFS claim and PA information.
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What you need to know about claim adjudication for February 1
Direct Data Entry (DDE) Providers
For those providers not using the EDI, AmeriHealth Caritas Ohio will be utilizing ConnectCenter (managed by Change Healthcare) at go-live on February 1. ConnectCenter leverages the Change Healthcare clearinghouse for processing claim submissions. It provides detailed error information to expedite corrections, claims tracking that indicates where in the adjudication process the claim is in and detailed claim reports.
We are offering free provider training sessions in January and February. Click a date below to register.
ConnectCenter Training
Medical Attachment Portal
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Registration is now open for the Provider Network Management module refresher training
Learning management system registration
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.
Training schedule
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.
- Accessing remittance advice.
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OhioRISE Advisory Council and Workgroups
The OhioRISE Advisory Council and Workgroup meetings commenced at the start of 2021. The purpose of these meetings is to engage with stakeholders to obtain critical feedback and expert advice for OhioRISE’s services and operations.
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You can find the members selected to be in the Advisory Council here and the presentation for the kickoff OhioRISE Stakeholder meeting on December 18, 2020 here. For a full list of upcoming Advisory Council and Workgroup Meetings, click here. |
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Comprehensive Primary Care Quarterly Informational Series
The Ohio Department of Medicaid invites you to the Comprehensive Primary Care (CPC) program year 2023s quarterly informational meeting series. This will take place virtually via GoTo Webinar on the following dates (all sessions are from 2:30 p.m. - 3:30 p.m.):
Tuesday, February 14
- Learn how to create and log in using an OH|ID account
- Hear different ways the MCO's can assist with activity requirements and care coordination
Tuesday, April 11
- Learn more details on improving foster care supports for youth
- Get tips on how to link up and communicate effectively with local schools
Tuesday, June 6
- Hear about some innovative CPC practice methods in the state
- Explore ways to improve risk stratification
Tuesday, September 12
- Learn some handy tips and tricks for enrollment in the CPC program
- Hear more about how PNM operates for CPC
- Gain insight on assigning user roles in PNM
*Please note: topics are subject to change therefore webinar details will be communicated prior to each session. |
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Comprehensive Maternal Care Informational Series
The Ohio Department of Medicaid invites you to the Comprehensive Maternal Care (CMC) program year 2023s informational meeting series. This will take place virtually via GoTo Webinar on the following dates (all sessions are from 2:30 p.m. - 3:30 p.m.):
Thursday, January 26, 2:30 p.m. - 3:30 p.m.
- Pregnancy Risk Assessment Form (PRAF)
- Attribution and payment files
- Activity requirements
Future sessions:
Thursday, February 23
Thursday, March 30
Thursday, May 25
Thursday, July 27
Thursday, September 28
Thursday, November 30
*Please note: the webinar details will be communicated prior to each session.
Register by clicking here.
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Tell us a little bit about where you’re from and where you went to school.
I was born and mostly raised in Youngstown after spending my early years in San Diego. I attended Ohio University and ultimately graduated with degrees in Health Administration and Health Management from University of Phoenix. I will graduate this year with my MBA with a concentration in Project Management.
Everyone at AmeriHealth Caritas Ohio (ACOH) has a story about why they joined the team. What’s yours?
I was excited about an opportunity to do things differently, a new plan in Ohio with a fresh perspective appealed to me.
With so many people bringing years of experience to ACOH, I was excited about us all coming together to roll out something great.
What drew you to this profession?
I started my career in 2001 on the commercial side working for Anthem Blue Cross Blue Shield. It was fast-paced and constantly changing which intrigued me. I have always had a desire to work in healthcare in some aspect and once I started, I never looked back.
What do you like to do in your free time?
I love to travel. I read a lot and love spending time with my family and friends. I’m an active member of my sorority, Delta Sigma Theta Sorority Inc., which allows me to give back to my community through service.
If you could have dinner with anyone in the world, dead or alive, who would it be? Why?
Maya Angelou simply because she was a woman who impacted and touched so many with her voice. After believing her voice was responsible for so much damage in |
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her family, she didn’t speak for five years. I’d like to know what she thought about in that silent time and when she discovered her voice mattered and could impact the world.
What are 2 apps (on your phone) you CANNOT live without?
I just feel like I have to look at TikTok and Airbnb daily. I am always planning a trip somewhere and since my first stay in an Airbnb I prefer that to a hotel. I am always looking for unique places to stay, next on my list is an A-frame.
Any interesting facts about yourself that you’d like to share?
I’m the proud mom of two recent college graduates. They graduated a week apart in May 2022! I have a passion for missionary work. My first trip was to Nicaragua in 2017 and I was scheduled to be in Tanzania in 2020 but the pandemic canceled my trip. I’m looking forward to the opportunity to travel again for missionary purposes.
Here I am in Nicaragua dressed as the clown “Florita,” which means flower. I was playing with children and passing out toys while their parents received toiletries.
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New Provider Orientation
AmeriHealth Caritas Ohio is hosting a series of virtual provider orientations. Please see the dates below and join your personal account executives online. Each session is held via Zoom from 10 a.m. - 11 a.m.
If you have attended an orientation session and have not completed the attestation, please click here to do so.
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Jan. 24 - Click here to register
Feb. 7 - Click here to register
Feb. 21 - Click here to register
Mar. 7 - Click here to register
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Welcome to our new providers!
Thank you for participating in our Ohio Medicaid health plan provider network. We would like to congratulate you on successfully completing your enrollment process. Your provider identification number will be your National Provider Identifier number (NPI). Look for your welcome packet to arrive within the next few weeks. In the meantime, you can visit our website to access:
- provider manual
- claims and billing info
- prior authorization list of services
- updates and newsletters
Your Account Executive is also available to assist you.
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Post-exposure prophylaxis (PEP) for measles
In efforts to minimize harm due to potential measles outbreaks within Ohio’s communities, AmeriHealth Caritas is partnering with ODM in support of our communities to ensure there are no coverage or payment barriers for children, adolescents, and adults who may need post-exposure prophylaxis (PEP) for measles.
Please note that AmeriHealth Caritas Ohio’s efforts to mitigate measles outbreaks include the following, beginning 2/1/2023 through 9/1/2023, prior authorization will not be required for measles-mumps-rubella (MMR) and/or measles-mumps-rubella-varicella (MMRV) vaccination regardless of network status for all providers.
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January is Cervical Health Awareness Month
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The Centers for Disease Control and Prevention (CDC) says that cervical cancer can be caused by a virus that is shared during intimate contact. It can almost always be prevented with screening. Any woman can get cervical cancer. Women who have early cervical cancer may feel perfectly healthy. That’s why the CDC says you should get a Pap test. Pap tests can find changes in cervical cells before they become cancer. To learn more about preventive care, click here. |
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Need help navigating all the changes?
Reach out to AmeriHealth Caritas Ohio provider services at 1-833-644-6001 or the Ohio Department of Medicaid provider hotline at 1-800-686-1516. We’re here to help! |
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Visit the Provider section of the AmeriHealth Caritas Ohio website for more information, news and resources. If you need assistance, please contact your assigned Account Executive.
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