ABCS RCM:
Advanced Billing & Consulting Services
Billing & Credentialing Solutions
We Help Next Generation Ohio Medicaid Providers
Streamline Your Medical Billing Process
Optimize your practice’s work flow with our ODM billing solutions.
Reliable & Experienced Billing Services:
At ABCS RCM, we realize that there is sometime a one-size-fits-all attitude in for medical billing services. However, as a company with many years of experience, we understand that every provider has unique needs and requirements.
As a company that is owned and operated in Ohio, we specifically tailor our services to meet the specific needs of healthcare practitioners who work with the Next Generation Ohio Medicaid system.
Currently, we are in communication with the Ohio Department of Medicaid. As they implement their new Next Generation of Ohio Medicaid program, there has been issues with their system. The Next Generation PNM platform has created claim denials and roster update problems for some healthcare providers.
To remedy this problem, we are:
Communicating with ODM Next Generation.
Track & remedy any ODM-generated denials.
Track & remedy ODM roster updating issues.
To Learn More, call us: (886) 460-2455
Professional billing solutions for Ohio providers who use the Next Generation Ohio Medicaid system. The Ohio Department of Medicaid (ODM) is updating their management information systems.
ODM is transitioning to a modular system called the Ohio Medicaid Enterprise System or OMES.
ODM's Next Generation Medicaid
Not sure what is changing and what is not changing?
Freguently Asked Questions about Ohio’s Next Generation Medicaid
What is the timeline for implementing Ohio’s Next Generation program?
The Next Generation of Ohio Medicaid program will be implemented in stages.
July 1, 2022: Ohio Department of Medicaid (ODM) launched the OhioRISE program.
October 1, 2022: Ohio providers could access the Single Pharmacy Benefit Manager (SPBM) and Centralized Credentialing. Providers can use the new Provider Network Management (PNM) module by accessing the MITS portal.
February 1, 2023: ODM will begin the Next Generation managed care plans. These are available through the managed care organizations (MCOs). This launch also includes a new Electronic Data Interchange (EDI) and a Fiscal Intermediary (FI).
TBA: ODM will add additional updates to their new Provider Network Management (PNM) module.
What is the Electronic Data Interchange (EDI)?
The Next Generation of Ohio Medicaid program’s EDI is designed to increase transparency and visibility of care services.
As part of the Ohio Medicaid Enterprise System, the company Deloitte is the EDI vendor and takes responsibility for all EDI HIPAA x12 transactions.
What is the Provider Network Management (PNM) module?
The new PNM modular component system will replace the Medicaid Information Technology System (MITS).
ODM’s Next Generation PNM module is designed to deliver a streamlined process for submitting and monitoring insurance claims.
The PNM module will also allow providers to submit and track prior authorizations, fee-for-service claims as well as other administrative tasks.
Will managed care members receive new ID cards?
All managed care members will need new Next Generation ID cards. However, if a member actively made a new plan selection or previously enrolled in Medicaid Fee-for-Service and recently enrolled in managed care. These members will continue to use their existing ID card.
For members who made a new plan selection during the open enrollment period, they will receive a new Next Generation ID card.
Does this impact MyCare Ohio plans?
Next Generation Medicaid managed care does not apply to members enrolled in MyCare Ohio plans.
How many MCOs are available?
There are now a total of seven MCOs (managed care organizations) to choose from in the ODM Next Generation Medicaid system.
The seven are MCOs are as follows:
- AmeriHealth Caritas Ohio, Inc.
- Anthem Blue Cross and Blue Shield
- Buckeye Community Health Plan
- CareSource Ohio, Inc.
- Humana Healthy Horizons in Ohio
- Molina Healthcare of Ohio, Inc.
- UnitedHealthcare Community Plan of Ohio, Inc.
Do providers have to contract with every MCO?
Ohio healthcare providers are not required to contract with all of the Next Generation managed care organizations. Healthcare providers can pick and choose which Next Generation MCO they would like to contract with for services.
Where can I find more information about ODM Next Generation?
Providers should explore Ohio Medicaid’s ODM Press. Formerly called the Managed Care Procurement Press, it is a short, periodic email update on the various ODM initiatives. It is a good source of information for Ohio providers, associations and advocacy organizations.
