The Ohio Department of Medicaid (ODM) completed the statewide rollout of the Next Generation MyCare program on Aug. 1. As members continue transitioning to the program, providers should be aware of requirements for contracting, claims submission and eligibility verification.
Provider contracting requirements
Providers may continue serving members who are changing plans or newly enrolling in MyCare for a limited transition period without contracting with a MyCare plan. After that transition period, providers must be enrolled with ODM and contract directly with the applicable MyCare plans to continue providing services.
Providers enrolled through the Ohio Department of Aging (AGE) may continue providing services and submitting claims during this period but must contract with the plans if they have not already done so.
Providers can review ODM’s Credentialing Guide and Requirements and Provider Frequently Asked Questions for additional information.
Submitting claims
MyCare claims must be submitted through the applicable health plan’s portal using Direct Data Entry (DDE) or through Electronic Data Interchange (EDI).
ODM has published a Provider Claims Submission One-Pager to help providers understand the process. Providers can also view ODM’s claims submission instructional video and consult the department’s HIPAA companion guides for additional guidance.
Verifying member eligibility
Providers should confirm a member’s Next Generation MyCare enrollment before providing services and submitting claims. ODM recommends two steps:
If enrollment cannot be verified after completing these steps, providers should contact Member Services and consult ODM’s existing billing guidance.
Need assistance?
Providers with questions about claims, prior authorizations, contracting, member eligibility or other provider-specific functions can contact the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov. The helpdesk is available Monday through Friday, 8 a.m. to 4:30 p.m. Eastern time.
For additional information about where to direct questions, consult ODM’s Provider Help Desk One-Pager.