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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.

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.

From the main screen, you will need to select one of the buttons at the bottom of the screen. If this is your first visit to this website, you should select “new application.” On the next screen you will be asked to select your Enrollment Type, Action Request and Provider Type. If you are a doctor, nurse or an individual that wants to provide services to someone living in their own home, you should select “individual practitioner.” The system will then ask you to select the appropriate action request and provider type. Your selection of “Provider Type” response is extremely important. If you are unsure of what provider type to request, you should contact the Enrollment/Revalidation Hotline at 1-800-686-1516 for additional information.  After you have entered your basic demographic information, the system will issue you an Application Tracking Number (ATN). You should record this ATN immediately, because it will serve as your secure 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.  Note: In order to prevent possible system errors due to internet browser variance please complete the application in all CAPS.

ODM is in the process of modernizing its management information systems, moving away from MITS to ODM’s new provider network management (PNM) portal. During this process, there will be dates on which the agency will temporarily freeze (not accept or process) provider enrollment applications. Information about those dates as well as training on the new platform is available at : https://managedcare.medicaid.ohio.gov/wps/portal/gov/manc/managed-care/centralized-credentialing

Any accurate and complete application submitted before the system freeze date will be processed by ODM staff. Inaccurate or incomplete applications will not be processed. 

Providers whose applications have not been processed prior to the system freeze will be asked to re-enroll through the new Provider Network Management system once it is operational.  Please note that while it’s possible to backdate applications up to 365 days, doing so may result in claims for services rendered being denied initially by the MCO. If that occurs, provider claims  need to be resubmitted to the MCO once the ODM enrollment process is completed.
 

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 2020 is $595 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. Select the “enrollment tracking search” link.

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 notification letter, with instructions for revalidating, approximately 90 days before their revalidation deadline. Providers with multiple provider numbers must revalidate each provider number individually. Providers will receive a separate letter for each provider number. The notification letters will be mailed to the “mail to” address on record with ODM. Providers should make sure their address information is correct. (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 Enrollment/Revalidation Hotline at 1-800-686-1516. Providers should not take any steps to revalidate until they receive their notification letters.

The revalidation notification letter will contain a special revalidation identification number. Providers will log in to the Ohio Medicaid Provider Portal by using this special revalidation identification number (the revalidation notification letter has the specific internet address of the revalidation starting web page). Once a provider has logged in, 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 and submit the revalidation application in a timely manner will be deactivated/terminated from the Ohio Medicaid Program.

If you have misplaced your revalidation notice letter and can’t enter your special revalidation identification number, you can call the Enrollment/Revalidation Hotline 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 2020 is $595 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.

To become an Ohio Medicaid Provider, simply complete a web-based 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. The Ohio Medicaid Provider application can be found online here: https://portal.ohmits.com/Public/Providers/Enrollment/tabId/83/Default.aspx

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 2021 is $599 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)