Ohio Medicaid is streamlining and centralizing provider requirements
The Ohio Department of Medicaid (ODM) is modernizing its systems and processes to better manage the program. Two in-flight efforts include:
- A technology transformation to streamline provider enrollment and claims administration through a modular system which will ultimately replace the Medicaid Information Technology System (MITS) used today.
- A simplified credentialing process for independent medical providers who wish to enroll in Medicaid’s program.
Change is on the way for providers!
In 2016, the Centers for Medicare and Medicaid issued guidance on enhanced federal funding related to Medicaid Information Technology (IT) in both Medicaid Management Information Systems (MMIS) and Medicaid Eligibility and Enrollment (E&E) Systems. The agency also revised the conditions and standards state Medicaid IT systems must meet to qualify for enhanced federal funding. It urged states to leverage proven, commercial-off-the-shelf technology solutions and adopt a modular approach to technology upgrades.
ODM responded by creating the Ohio Medicaid Enterprise System (OMES) – a modular technology framework that integrates the critical capabilities and functionality of today’s siloed systems.
On March 8, 2021, ODM will launch the first component of the OMES platform -- the Provider Network Management (PNM) module – as well as a new provider portal. Together these tools will ease the administrative requirements for enrollment and revalidation.
The PNM module will allow providers to submit change requests online vs. submitting by mail or e-mail. Its single-entry provider portal will streamline:
- Claims submissions,
- Prior authorization requests,
- Costing reports, and
- Eligibility verifications.
Also beginning March 8, credentialing for independent medical providers will be centrally managed through ODM’s nationally accredited Credentials Verification Organization (CVO).
Providers will no longer be required to undergo this time-intensive process foreach of ODM’s five managed care organizations. They’ll have one vendor to work with, one set of requirements to follow, and one date to manage renewal and revalidation. That means less paperwork, lighter administration, and more time to devote to patient care.
ODM will guide you through these transitions.
The PNM module and centralized credentialing will call on providers to make changes to how these functions are handled in the future.
ODM is in the early stages of provider outreach. In coming weeks, more information will be shared about what these changes mean to providers and how to prepare. Surveys will be sent to a randomized group of providers to identify the needs and concerns in managing this change. Results will then shape how ODM informs and trains providers for a successful, on-time transition.
In the meantime, providers with questions or comments should send them to ODM’s dedicated email boxes:
For more information about the next generation of Ohio’s Medicaid managed care program and the role centralized credentialing will play, visit