Managedcare.medicaid.ohio.gov

Goals of the Next Generation Program

WEBOhio Medicaid’s Next Generation managed care program advances many of our goals through Ohio Department of Medicaid’s (ODM’s) population health approach. This …

Actived: 7 days ago

URL: https://managedcare.medicaid.ohio.gov/managed-care/ohio-next-generation-managed-care-2/02-goals-of-the-next-generation-of-ohios-medicaid-managed-care-program

Ohio Medicaid selects Aetna Better Health of Ohio for Specialized

WEBOhio Medicaid selects Aetna Better Health of Ohio for Specialized, Child-Focused Managed Care Plan. April 05, 2021. For immediate release: April 5, 2021. Lisa …

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Next Generation Managed Care Benefits

WEBCommunity investment: Together, with the Next Generation managed care plans, Ohio Medicaid is investing in the local communities where members live by working with …

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About OhioRISE Ohio Medicaid Managed Care

WEBAbout OhioRISE. OhioRISE aims to shift the system of care and keep more kids and families together by creating new access to in-home and community-based services for …

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Ohio Department of Medicaid Announces Six Partners to Further …

WEBOhio Department of Medicaid Director Maureen Corcoran today announced the selection of six health care organizations to lead the department’s evolution of …

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Credentialing Guide and Requirements

WEBCredentialing Requirements – Individuals. The following are required for all individual providers: CAQH Form. Licensure in the state from the state where you practice. …

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OhioRISE Overview for Children, Youth, and Caregivers …

WEBUpdated 08/14/2023 Page 1 OhioRISE Overview for Children, Youth, and Caregivers Receiving MRSS What is OhioRISE? OhioRISE is a specialized Medicaid managed care …

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OhioRISE (Resilience through Integrated Systems and Excellence)

WEBAs a part of Ohio Medicaid’s effort to launch the next generation of Medicaid, ODM has launched OhioRISE (Resilience through Integrated Systems and Excellence), …

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Resources for Prescribers, Pharmacists, and Pharmacy Support …

WEBAs of October 1, 2022, ODM SPBM, Gainwell Technologies, is responsible for managing pharmacy services including a specialty pharmacy program for all Medicaid managed …

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Resources for Community Partners and Providers

WEBOhio Department of Medicaid (ODM) holds office hours for community partners and providers to raise questions to OhioRISE subject matter experts to help ongoing …

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About the SPBM and PPAC

WEBThe Pharmacy Pricing and Audit Consultant (PPAC) works in coordination with ODM and Gainwell to improve transparency, accountability, and efficiency within ODM’s pharmacy …

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OhioRISE Frequently Asked Questions

WEBUpdated June 30, 2022 *Additional information may be added, and all content is subject to change as OhioRISE is implemented. OhioRISE . Frequently Asked Questions

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Provider Contracting Information

WEBAll pharmacies will have to contract with Gainwell to provide pharmacy services for Medicaid managed care members. For pharmacy contracting questions, Gainwell may …

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Submitting Claims and Prior Authorizations

WEBAs of October 1, 2022, the Single Pharmacy Benefit Manager (SPBM) is the entry for pharmacy claims and prior authorizations for managed care members. This does not …

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Centralized Credentialing FAQ

WEBDelegated credentialing is when a hospital system or other organization enters into a memorandum of understanding (e.g., delegated agreement) with ODM, allowing the …

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OhioRISE Provider Enrollment and illing Guidance

WEBv Legal Disclaimer: Ohio Department of Medicaid (ODM) strives to make the information in this guidance document as accurate, complete, reliable, and timely as …

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Care Management Entity Manual

WEB♦. medicaid.ohio.gov. Governor Mike DeWine . ♦. Lt. Governor Jon Husted . ♦. Director Maureen Corcoran. Care Management Entity Manual. Version 1.2 ♦ …

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