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The Ohio Department of Medicaid (ODM) is initiating training for their newly created Next Generation program. The training is intended for agencies and associations that provide Medicaid funded medical and healthcare services for Ohioans.

ODM is transitioning to program called the Ohio Medicaid Enterprise System (OMES). Ohio Medicaid is working on educating healthcare providers who interact with ODM. As a company, ABCS regularly works closely with a variety of healthcare and personal care providers. These include community behavior health, HCBS Waiver Providers as well as other medical agencies.

Ohio Next Generation Managed Care:

The Ohio Department of Medicaid started the transition process to the Next Generation managed care program a few years ago. The goal is to avoid any unnecessary disruptions in the delivery of healthcare services.

There are three general stages of implementation for the Next Generation of Ohio Medicaid program. The hope is that the gradual rollout will reduce the occurrences of misinformation and/or confusion.

Stage 1 – July 1, 2022: This portion focuses on the recently developed OhioRise program which stands for Resilience through Integrated Systems and Excellence. The focus of OhioRise is to improve the state’s ability to provide supports for adolescents with more complex behavioral health needs. The program hopes to better coordinate the delivery of healthcare and supportive services between multiple state systems.

Stage 2 – October 1, 2022: The state will launch their updated credentialing system. The Centralized Provider Credentialing system is intended to reduce the administrative burden that credentialing can sometimes create for healthcare providers. This stage also includes a consolidated pharmacy service for all Medicaid managed care plans known as the Single Pharmacy Benefit Manager or SPBM.

Stage 3 – December 1, 2022: This is when the next Generation of managed care plans are scheduled to start. The goal is for members to experience better access to healthcare as well as care management. The Ohio Department of Medicaid has also stated that they plan to improve and streamline the overall process of claims submissions and prior authorization for healthcare providers.

Provider Network Management Portal:

Ohio Department of Medicaid is redesigning the insurance credentialing aspect of the program. It is sometimes a challenge for medical providers to establish and maintain their access/privilege to insurance networks.

In order to assist and streamline the credentialing process, Ohio will have the Provider Network Management (PNM) portal accept Medicaid enrollments for healthcare providers, as well as become a centralized processing point for related credentialing functions.

This means that healthcare practitioners will eventually no longer need to establish and maintain credentials in each separate Ohio managed care organization (MCO). Instead, they will only need to establish their medical credentials one time.

ODM has stated that they would like to reduce the administrative tasks for medical professionals and caregivers. This in turn should hopefully allow for greater focus on the more meaningful and important work of providing quality care to Ohioans.

Components or modules of the new Provider Network Management Portal will replace the older MITS Provider Enrollment System. As the state upgrades its provider enrollment system and moves closer to the go live date, they will release additional information and training opportunities on this transition.

However, until ODM starts accepting claims through their Ohio Medicaid Enterprise System (OMES) modules, provider health care claims should continue to be submitted according to the MCO billing guidance. For more information on this topic, people should regularly monitor the Ohio Department of Medicaid’s website.

Who We Are:

As a company, ABCS RCM has delivered billing, insurance credentialing and marketing services to behavioral health and other healthcare agencies for many years. This includes delivering account management, EVV software and billing services to Ohio Medicaid Waiver Provider Agencies.

As an Ohio-based company, they are proud to deliver software tools, EVV and billing services for agencies that provide supports for the Ohio I-DD community. They understand the challenges that healthcare professionals face when providing quality services and treatments.

Advanced Billing & Consulting Services provides a variety of administrative solutions for healthcare practitioners. Their professional services include medical billing, insurance enrollment and credentialing monitoring services as well as digital marketing for medical practices and healthcare agencies.

To learn more, email or call them at 614-890-9822 or 866-460-2455.

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