Ohio Medicaid and Managed Care Organizations
Today, more than 90 percent of Ohio Medicaid members are supported by managed care organizations (MCOs). During the year ahead, ODM will begin implementing a new vision for care; focusing on the individual, a strong partnership among MCOs and the department, and supporting specialization in addressing critical needs.
Common Questions
Popular Resources

Welcome Providers
Provider News & Resources
Welcome Providers

Policies & Guidelines
Ohio Medicaid policy is developed at the federal and state level. It guides how we operate our programs and how we regulate our providers. This page contains resources for the Ohio Medicaid provider community, including policy and advisory letters, billing guidance, Medicaid forms, research, and reports.
Policies & Guidelines

Electronic Visit Verification
Electronic Visit Verification (EVV) is used by caregivers for some home and community based services to document the time services begin and end. The Ohio Department of Medicaid provides an EVV system at no cost to all providers. Agency providers may choose to use an alternate EVV system.
Electronic Visit Verification

Prior Authorization Requirements
Links to Ohio Medicaid prior authorization requirements for fee-for-service and managed care programs.
Prior Authorization Requirements

Episode-based Payments
Episode-based payments is a part of quality-driven payment innovation programming in Ohio Medicaid.
Episode-based Payments

Comprehensive Primary Care
Ohio CPC is an investment in primary care infrastructure intended to support improved population health outcomes.
Comprehensive Primary Care

Specialized Recovery Services
The Specialized Recovery Services program assists adults with severe and persistent mental illness, certain diagnosed chronic conditions, and those actively waiting on specific transplant lists.
Specialized Recovery Services

Fee Schedule & Rates
Disclaimer about fee schedule and rates available for providers.
Fee Schedule & Rates

Training
Training presentations, videos, and handouts.

MITS
Medicaid Information Technology Information System (MITS) Resources

Managed Care
The next generation of Ohio Medicaid managed care is designed to improve wellness and health outcomes, support providers in better patient care, increase transparency and accountability, improve care for children and adults with complex behavioral needs, and emphasize a personalized care experience.
Managed Care

Programs & Initiatives
The Ohio Department of Medicaid has many programs and initiatives to enhance the quality of care for patients and support our providers in the work they do each day.
Programs & Initiatives

COVID-19
Ohio Department of Medicaid COVID-19 Resources and Guides for Providers

Billing
Provider billing and data exchange related instructions, policies, and resources.

Enrollment & Support
Ohio Medicaid is changing the way we do business. We are streamlining provider enrollment and support services to make it easier for you to work with us. Information about provider enrollment and assistance is located here.
Enrollment & Support

Managed Care Procurement
New Medicaid Managed Care contracts to reframe the system of coordinated health care for Medicaid Members.
Managed Care Procurement

Provider Network Management (PNM) & Centralized Credentialing
A centralized portal to reduce the administrative burden on providers by streamlining the process for provider certification.
Provider Network Management (PNM) & Centralized Credentialing

OhioRISE (Resilience through Integrated Systems and Excellence)
A specialized Medicaid managed care plan with tailored services to meet the needs of youth with complex needs.
OhioRISE (Resilience through Integrated Systems and Excellence)

Ohio Medicaid Single Pharmacy Benefit Manager (SPBM)
A single system to improve management and administration of pharmacy benefits for managed care recipients while decreasing costs for the state.
Ohio Medicaid Single Pharmacy Benefit Manager (SPBM)

Fiscal Intermediary
A single point of entry for all provider claims and prior authorization requests.
Fiscal Intermediary

Successor Liability Agreements
Model agreement language for use by a nursing facility or intermediate care facility for individuals with intellectual developmental disabilities when closing or executing a change of operator.
Successor Liability Agreements

Automated Cost Reporting
Policy updates and links to submission instructions for various cost reports.
Automated Cost Reporting

Home Health Services
Description of home health services, who is eligible to receive them, and requirements for providers, along with related links.
Home Health Services

Nursing Facilities
Cost Report, Rate Setting, Case Mix, Prior Authorization FAQs, Fact Sheets, Other Resources.
Nursing Facilities