The Ohio Department of Medicaid (ODM) has completed its rollout of the Next Generation MyCare program across the state. As members continue transitioning into the program, there are a few important things you should know to provide services and support their care.
Providing Services
If you serve members who are changing plans or newly enrolled in the program, you can continue to provide services for a certain amount of time without having a contract with the MyCare plans.
If you want to continue to serve members past their transition period, you must enroll with the ODM and contract with the MyCare plans directly. Ohio Department of Aging (AGE) enrolled providers can continue to provide services and submit claims but must contract with the plans if you have not already.
Refer to the Credentialing Guide and Requirements Document or Provider Frequently Asked Questions for more information.
Submitting Claims
Claims for MyCare members can be submitted to the plan’s portal using Direct Data Entry (DDE) or via Electronic Data Interchange (EDI). View the Provider Claims Submission One-Pager or How Do I Submit Claims for Next Generation MyCare Members? Micro Video to learn more about the process and determine which method to use if you are new to billing in the program. You can also refer to the Companion Guides for more guidance and resources.
Helping members receive care is ODM’s priority. When you provide services to members, you can take the following actions to verify if an individual is enrolled in a MyCare plan:
- Check the member ID card. If the ID card has a Next Generation MyCare program logo, it is indicative that the member is a Next Generation MyCare member.
- Check member eligibility via Provider Network Management (PNM) or the EDI 270/271 process.
If you encounter issues verifying a member’s enrollment after completing these steps, contact Member Services and follow existing billing guidance.
- For questions about claims, prior authorizations, contracting, member eligibility, or other provider-specific functions, contact the ODM Integrated Helpdesk by calling 800.686.1516 or emailing IHD@medicaid.ohio.gov Monday through Friday, 8 a.m. – 4:30 p.m. Eastern Time.
View the Provider Help Desk One-Pager to learn more about where to go for help.