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Recent Updates

 
The Ohio Department of Medicaid (ODM) Next Generation Program - Provider Updates for October 1 Launch
 
On October 1, ODM will launch the Provider Network Management (PNM) module and Centralized Credentialing, which will reduce administrative burden on providers. At the same time, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members.
 
To prepare for these changes, providers should set up their OH|ID and associate their existing accounts. The OH|ID Pre- registration site is available through September 23 and can be found at: https://pnm-preregistration.omes.maximus.com. The OH|ID is necessary for anyone that will access the PNM or SPBM modules. Establishing login credentials during Pre-registration will ease the transition and prevent disruptions to system access for providers ahead of the October 1 launch.
 
In preparation for the launch of the PNM and SPBM, ODM is offering a variety of trainings. These trainings are a great opportunity for providers to gain knowledge that will benefit our members!
 
PNM Trainings
We are offering several PNM training opportunities, which began August 1. Using the Learning Management System (LMS), Absorb, providers will be able to access self-paced training sessions and sign up for virtual and/or in-person learning. It is important that providers create an account, using the Job Aid, in the LMS to secure access to all training sessions, answer forms, and PNM resources in advance. Trainings will cover topics including:
  • PNM login and access
  • System navigation
  • New enrollment applications
  • Demographic updates
  • Revalidations
 
SPBM Trainings
We are also offering several SPBM training opportunities, which will begin September 6. Training is offered via online instructor- led webinars, recorded online training, and weekly Q&A forums. Registration for training is now open. Registration instructions are available by navigating to https://spbm.medicaid.ohio.gov and selecting the Provider tab. Trainings will cover topics including:
  • SPBM login and access
  • System navigation
  • Verifying member pharmacy benefit eligibility
  • Submitting and viewing pharmacy claims
  • Submitting and viewing pharmacy prior authorizations
 
How can I learn more about the October 1 changes for providers?
In July, ODM hosted a webinar for providers on the Next Generation's Stage 2 October 1 launch. This webinar included an overview of the new modules and upcoming provider training plans and dates. Please see below for a recording of the session and the corresponding slides.
 
You can also check out the PNM & Centralized Credentialing and Single Pharmacy Benefit Manager (SPBM) webpages. For questions about the Next Generation program, contact ODMNextGen@medicaid.ohio.gov.
 
Please also subscribe to the ODM 2022 Press, ODM’s provider newsletter, to stay up to date on upcoming changes including more information about the Stage 2 and Stage 3 launches of the Next Generation of Ohio Medicaid.
 

Throughout July, the Ohio Department of Medicaid (ODM) is offering informational webinars discussing the Oct. 1, 2022 Next Generation Medicaid Program Stage 2 launch. Find out more on the ODM website here, or read the Molina Provider Bulletin here
 
The Combined Provider Manual effective as of July 1, 2022 is posted here.
 
The current PA Code List became effective July 1, 2022. View it here.
 
As of April 1, Molina began a collaboration with New Century Health, a cardiology quality management company, to conduct medically necessity review on certain codes requiring PA. Learn more here.
 
Based on guidance from ODM, Molina began denying claims submitted by non-enrolled or inactive providers on Aug. 15, 2021. Learn more here and here.
 
View the Molina COVID-19 (Coronavirus) resource page with codes, telemedicine information and support materials here. For additional information visit the CDC website here, or the Ohio Department of Health website here.
 

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