With the Next Generation of Ohio Medicaid Managed Care there is a change from the managed care entities (MCEs) having the responsibility for provider credentialing to Ohio Department of Medicaid (ODM) moving to a centralized model in which the agency will manage credentials. Beginning on October 1, 2022 the Provider Network Management (PNM) module will accept Medicaid or MyCare provider credentialing request and carry out centralized credentialing functions.
Recredentialing applications for Ohio Medicaid / Ohio MyCare for the months of Oct, Nov, Dec 2022 and Jan 2023 will be completed by CareSource. Per the Centers for Medicare and Medicaid Service (CMS) and National Committee for Quality Assurance (NCQA) rules, a provider is required to go through the process at initial enrollment and every 36 months thereafter.
Will a provider still need to be credentialed by an MCO?
If a provider is participating with a managed care organization for Medicaid-only credentials or MyCare credentials, the credentialing process will be done through ODM (PNM module). Providers who participate in Medicaid’s fee-for-service model also must complete this process. They will not be credentialed at the MCO level. However, providers participating in non-MyCare Medicare and Marketplace programs are mandated by CMS to be credentialed by the MCOs. Additionally, a provider will still need to contract with a given MCO in order to participate with them.
How can the Provider Network Management (PNM) module be accessed?
Beginning October 1, all Medicaid providers will need an OH|ID, the State of Ohio’s digital identity standard, to access Medicaid’s new Provider Network Management (PNM) module secure web portal. The PNM module is the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service. The PNM module has replaced MITS provider portal.
Why this is important:
The OH|ID is required to securely access state agency systems. It gives providers a single set of logon credentials to securely access state agency systems, including Medicaid’s, from any device. The ID adheres to best practice security and privacy regulations as defined by the National Institute of Standards and Technology (NIST). Agencies and users using the OH|ID can rest assured that their digital identities are kept safe and secure.
Get your State of Ohio digital identification – the OH|ID today.
Providers needing technical assistance should contact the Ohio Department of Medicaid Integrated Help Desk (IHD) at 1-800-686-1516. Hours of operation are Monday-Friday, 8 a.m. – 4:30 p.m. ET.
For more information, please visit the PNM and Centralized Credentialing website.