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Provider Enrollment
Common Questions about Provider Enrollment
Provider Enrollment

If you are reading this document, you have come to the right place. In order to become an Ohio Medicaid Provider, you must complete a web-based electronic application. Ohio does not accept paper applications. Our web-based provider application is designed to walk you through the steps in order to submit all the information that the Ohio Medicaid program needs to enroll you as a new provider. Please go to the Medicaid Provider Portal to access the online application. 

Yes., A provider can request retroactive enrollment up to 365 days, according to Ohio Administrative Code rule 5160-1-17.4. You should apply for a retroactive application if you have been providing services to managed care or fee for service members.

No. The provision in 42 CFR 438.602(b) does not require providers to render services to FFS beneficiaries.

Yes. The state (ODM) must screen, enroll, and periodically revalidate all MCO network providers as required in the code of federal regulations 42 CFR 438.602(b). This means that any provider an MCO has listed as a “network provider” must be active in ODM’s Medicaid Information Technology System (MITS). Any network provider that chooses not to enroll with ODM will be terminated from the MCO provider network under federal requirements. 

Per ODM guidance, MCOs must use their contracting processes to ensure providers enroll with ODM if they have not enrolled previously. After three documented outreach attempts over at least a thirty-day period, MCOs may deny claims for providers who fail to enroll with ODM. MCOs may deny claims for providers who fail to revalidate with ODM Provider Enrollment.

First, you should open the following link: “Ohio Medicaid Online Application” to access Ohio Medicaid’s online application. From the main screen, you will need to select the “New Provider” button located on the top right side of the home page screen.

On the next screen you will be asked to select your application Type. For example, if you are a doctor or nurse you should select “Standard Application” you should select “individual practitioner”. However, if you are an individual that wants to provide Ohio Department of Medicaid waiver services to someone living in their own home you should select “Medicaid Waiver (ODM)”.

 

The system will then ask you to provide basic demographic and identifying information along with your provider type selection. Your selection of “Provider Type” response is extremely important. If you are unsure of what provider type to request, you should contact the Integrated Help Desk at 1-800-686-1516 for additional information on additional resources that can help you make this determination. 


After you have entered your basic demographic information, the system will issue you a Registration ID. You should record this Registration ID immediately, because it will serve as your key to return to your application or to track it through the enrollment process.
 

 

The web-based application will take you through a series of screens depending on your provider type. Be sure to read and answer the questions correctly. Whoever knowingly and willfully makes false statements or representations on this application may be prosecuted under applicable federal or state laws.

Once you have completed the application, the system will provide information regarding next steps. Your next steps could include uploading or submitting additional documentation necessary for enrollment. Failure to submit the documents as required could cause your application to not be processed and you will have to begin the process all over again.
 

All providers are required to be screened and enrolled by the state Medicaid agency. Not all providers, however, are required to go through the credentialing process. For individual providers, only licensed providers that are able to practice independently under state law are credentialed. See 5160-1-42(B)(C)(D) for the complete list and definitions.

The time it takes to process an application depends on the number of applications submitted. There is no magic formula in determining how soon or how long it will take to process your application. The best way to ensure that your application is processed timely, is to complete it correctly and submit all of the necessary documents as required. Errors on your application or missing documents will cause your application to be rejected and place it back at the rear of the work queue.

Individual Practitioners should select “sole proprietor” from the pull-down menu.

Yes, organizational provider types will be required to pay a fee. The fee applies to organizational providers only; it does not apply to individual providers and practitioners or practitioner groups. The fee is a federal requirement described in 42 CFS 445.460 and in OAC 5160:1-17.8. The fee for 2022 is $631 per application and is not refundable.

The fee will not be required if the enrolling organizational provider has paid the fee to either Medicare or another State Medicaid agency within the past five years. However, Ohio Medicaid will require that the enrolling organizational providers submit proof of payment with their application. (See OAC 5160:1-17.8 )

Once an application has been submitted, you can go to the Medicaid Provider Portal to check the status. From the providers home page select the Registration ID of interest.  Once you select the registration id link you will be taken to the ”Provider Management Home” page. The “My Current and Previous Applications” panel, contained on this page, provides details on the “PNM Application Status”.

Once a provider is enrolled, they will be sent an email confirmation which will also contain the Medicaid Welcome Letter. This will be sent to the email that was provided during the application process.

ODM’s provider enrollment process requires all applicants to submit a W-9 form with the application. This form is collected for all provider types as a signed statement attesting that the social security number or employer identification number that is being used, actually belongs to the applicant. The W-9 form is not submitted to the IRS and it is maintained in ODM’s secure provider management system. Signing and submitting a W-9 does not mean that a provider will automatically receive an IRS 1099 at the end of the year. Only billing providers who have received more than $600 in payments from ODM will receive a 1099.

You may request the effective date of your Medicaid provider enrollment to be retroactive up to twelve months prior to the application submission date.  Ohio Medicaid may grant retroactive enrollment but that determination will be made during the processing of the application and if/when certain dependent variable are satisfied.  

Yes, even if a provider has revalidated their provider agreement with Medicare, they must complete the revalidation process with Ohio Medicaid.

Providers will be asked to review their current provider information and either verify that information or provide updates. This will include information regarding licenses and credentials. Some providers will be asked to provide additional information, to comply with new ACA disclosure requirements. All providers will also have to sign a new Medicaid provider agreement (through electronic signature when revalidation application is submitted). Some providers could be asked to submit certain specific documents as a part of the revalidation process. The ODM will verify the submitted information and in some instances, conduct an on-site visit.

Providers will receive a revalidation notice, with instructions for revalidating, approximately 120 days before their revalidation deadline. Providers with multiple provider numbers must revalidate each provider number individually. Providers will receive a separate notice for each provider number. The notifications will be mailed to the “Correspondence Address” on record and emailed to the email address on record with ODM. Providers should make sure their “Correspondence Address” and email address information is accurate. (Note: Providers are required to notify ODM within 30 days of changes in address.) Providers can review or update their address information by logging into the Ohio Medicaid Provider Portal Providers needing assistance should contact the Integrated Help desk at 1-800-686-1516. Providers should not take any steps to revalidate until they receive their revalidation notice.

The revalidation notice will contain instructions on accessing and starting the revalidation process for a provider. . Providers will log into the Ohio Medicaid Provider Portal  by using this special revalidation identification number as indicated in the revalidation notice.. Once a provider has logged in, they should select “Begin Revalidation” link.  The system will guide them through the revalidation process. Some providers may be required to submit additional documentation as a part of their revalidation process. Providers that fail to complete the revalidation process in a timely manner will be deactivated/terminated from the Ohio Medicaid Program.

If you have misplaced your revalidation notice, you can call the Integrated Help Desk at: 1-800-686-1516 and they can assist you.

Yes, certain provider’s types will be required to pay a fee. Effective March 1, 2013, Ohio Medicaid will start collecting a non-refundable application fee when an initial application to enroll as a Medicaid provider is submitted and also at revalidation of the provider agreement. The fee applies to organizational providers only; it does not apply to individual providers and practitioners or practitioner groups. The fee is a federal requirement described in 42 CFS 445.460 and in OAC 5160-1-17.8(C). The fee for 2022 is $631 per application.

The fee to Ohio Medicaid will not be required if the revalidating organizational provider has paid the fee to either Medicare or another state’s Medicaid provider enrollment within the past two years. However, Ohio Medicaid will require that the revalidating organizational providers submit proof of payment with their revalidation application. (See OAC 5160-1-17.8(C))
 

Section 6401(a) of the Affordable Care Act (ACA) requires a fee to be imposed on each institutional provider of medical or other items or services and suppliers. The fee is to be used to cover the cost of program integrity efforts including the cost of screening associated with provider enrollment processes, including those under section 1866(j) and section 1128J of the Social Security Act. 

Organizational providers that are required to pay a revalidation fee will be able to make a secure on-line payment while completing their revalidation application. The payment must be made by credit card (Discover Card, MasterCard or Visa). Other types of payment will not be accepted. Providers will not be able to complete the revalidation application until the fee is paid or proof of previous payment is provided.

Providers who ultimately do not revalidate will be terminated. If the provider decides to reactivate their Medicaid number beyond the window of opportunity for revalidation will be have an inactive span in their contracts based on when they completed the revalidation action. This means there will be a gap in their ability to submit and be reimbursed for claims during this inactive contract span. These providers will be ineligible for retroactivity.

The ODM will continue to provide information about revalidation as new questions are raised. Providers can also go to the Code of Federal Regulations -- 42 CFR 455.414 for more information or access The Centers for Medicare and Medicaid Services web site at: www.cms.gov. You may also visit OAC 5161-1-17.4 for additional information on the revalidation requirement and process.

Any provider identified by the National Uniform Claim Committee (NUCC) with a provider taxonomy number must obtain an NPI and report it to Medicaid upon enrollment. If you are unsure you can call the Enrollment/Revalidation hotline at 800-686-1516.

Individual providers must submit their SSN. In addition all organizational providers must provide the SSN, date of birth and birth place of all individuals that own 5 percent or more of an organization or that have a controlling interest. Organizational providers are also required to disclose the same information of managing employees. (See Provider disclosure requirement) – OAC 5160-1-17.3 ).  If you are an individual practitioner that will be practicing and billing under a “group” practice you must still provide your SSN on the application and not the group FEIN. Note: A Social Security Number (SSN) is required by State and Federal law of all individuals applying to obtain a Medicaid provider number. Entering an invalid SSN or entering a FEIN in the place of a SSN may result in the rejection of your application.