A nursing facility provider should first contact the Ohio Dept. of Health (ODH) to see if a Certificate of Need is required. When they are approaching the time to be able to admit residents, they will need to submit a Medicaid application through the MITS portal and submit a readiness letter to the ODH so a survey of the facility can be scheduled. Once ODH surveys and certifies the facility, ODM is able to process the enrollment.
Centralized credentialing refers to ODM or its designee leading the credentialing functions for ODM providers, eliminating the need for providers to understand and comply with six unique credentialing processes that are currently supervised via Medicaid’s managed care plans. Instead of having to submit information to six different health plans, centralized credentialing helps eliminate repetitive work, improve revenue cycle, and lower credentialing costs for hospitals, facilities, providers, and practices.
As the centralized credentialing program is being developed in tandem with the new Provider Network Module system, this will go live on 3/8/2021
Independently licensed medical/behavioral health professionals as well as certain organization/facility types require this process - please see the credentialing rule for a complete list
No. MITS does not currently have the functionality required for a credentialing program, so until the new Provider Network Module is live, please continue to credential with the Managed Care Plans.
No - there will be one application submitted for both enrollment and credentialing. At the time of revalidation, re-credentialing will also be completed
An ICF-IID provider should first contact the Ohio Dept. of Developmental Disabilities (DODD) to obtain development approval. When they are approaching the time to be able to admit residents, they will need to submit a Medicaid application through the MITS portal and submit a readiness letter to the ODH so a survey of the facility can be scheduled. Once ODH surveys and certifies the facility, ODM is able to process the enrollment.
The provider agreement states the provider may terminate the contract by providing ODM, and the residents of the facility and their sponsors, written notice of the facility closure at least ninety (90) days prior to the facility closure and relocation of residents.
Nursing facility providers should send an email to NFPolicy@medicaid.ohio.gov.
A nursing facility provider should contact the Ohio Dept. of Health (ODH) regarding licensure and certification. An ICF-IID should contact DODD regarding licensure and ODH regarding certification.
A LTC provider having issues with claims should call Provider Assistance at (800) 686-1516.
The Incoming operator and exiting operator will need to give The Ohio Department of Medicaid a 45-day notice (Provide address/name). That notice must be signed by both Enter and Exiting Operator or their Designee (Attorney).
The notice should provide the name, address, Medicaid Id, NPI and address of the exiting operator and the name of the entering operator, the date of the transaction, Type of Transaction, Lessee and Lessor information and instruction on where we send correspondences to.
Rules can be found in the (Ohio Revised Code) ORC section 5165.51
Yes
Yes, not just for Identity purposes but also to bill Ohio Medicaid for services rendered
A CHOP is a transaction in which no residents are impacted and where the entering Operator usually accepts the assignment of the exiting operator’s provider agreement. A New Facility application is one where the Facility is new to the program, takes over a previously occupied building that has no residents or the actual building of a brand facility where in residents are impacted. These facilities must be surveyed by ODH.
No.
Contact name above and a letter with the new anticipated effective date of the CHOP.
A nursing facility provider should contact the Ohio Dept. of Health (ODH) regarding licensure and certification. An ICF-IID should contact DODD regarding licensure and ODH regarding certification.
For Nursing facilities, no as long as you have paid Medicare. For ICF’s, there is a fee and it should be paid to ODD