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Getting Help with PNM Module Issues and Questions

The Provider Network Management (PNM) module is currently experiencing intermittent connectivity interruptions with MITS. We appreciate your patience as we are working with our module vendors, Maximus and Gainwell, to resolve the issue as quickly as possible and to reduce increased help desk wait times. Click here for resources to assist you in resolving the most common issues providers are experiencing.

Important update

Ohio Medicaid is upgrading its claims payment system as part of the Next Generation of managed care program. Regarding the Ohio Medicaid Enterprise System (OMES) phased implementation approach, providers should be alerted that the Provider Network Management (PNM) module and MITS will be down for maintenance 11 a.m. Tuesday, January 31, through 7 a.m. Wednesday, February 1. Effective 7 a.m. February 1, the new Electronic Data Interchange (EDI) solution and the Fiscal Intermediary (FI) will be operational. If providers use the PNM module and MITS to conduct their direct data entry portal business, that functionality will also be available at 7 a.m. February 1. If you add/update hospice data in the MITS portal after 7 p.m. on Sunday, January 29, it will not be made available for claims processing until 7 a.m. on February 1.

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.

Prescribers, pharmacists, and support staff – SPBM Web Portal training recording now available

The recorded SPBM Web Portal training is now available for prescribers, pharmacists, and support staff.  Viewing this training is important for prescribers, pharmacists, and support staff to learn about the many tools available on both the public facing and secure portal.  The public facing portal includes access to reference material such as the Unified Preferred Drug List and criteria.  The secure portal, which requires log in credentials, provides access to specific patient information and the ability to reach the SPBM Clinical help desk via web chat. SPBM Clinical staff can also be reached via phone and email. 

To access the recordings, please follow the below links: 

If you have accessed Gainwell’s Ohio Learning Management System (LMS) previously, please use the same credentials set up during your registration to log in. If you have not, you will need to complete registration for the system to access the recording.

If you have questions, please contact Gainwell Technologies by phone at: 1-833-491-0364 or by email at: OH_MCD_PBM_network@gainwelltechnologies.com.  

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Update: Reconciling October 14 advance payments

Ohio Medicaid will begin recouping advanced provider payments made October 14 that were offered due to connectivity issues between systems. Providers that billed through the portal using direct data entry and received an advance payment will see recoupment on the December 22 payment. 

Remittance advices will note the recoupment, distinguishing it from the standard claims payments. The recoupment will continue to offset in future payment cycles until it is recovered in full. Click here for more information.