Ohio Medicaid and Upcoming Centralized MCE Credentialing

 In Blog

The Ohio Department of Medicaid (ODM) has released new information concerning the move to centralized credentialing between Ohio Medicaid and the six Medicaid Managed Care Entities (MCE). In order to comply with CMS requirements, ODM is replacing their MITS provider enrollment system with their new Provider Network Management (PNM) system.  This system change is currently slated to occur in July 2022.

Along with this system change, there will also be an update in how provider credentialing is handled by ODM and the MCEs.  The new process will be centralized, with enrollment applications submitted to ODM in the PNM system and processed for both Medicaid and the MCEs. Credentialing applications will be processed by Maximus, Inc., a credentialing verification organization maintaining NCQA requirements.

What does this mean for practices?

It means that only one application for a provider needs to be submitted to ODM.  Once the credentialing process for the provider is approved, that information will be passed on to the MCEs.  Practices will not have to submit separate credentialing applications to each of the MCEs, which will save time.

This change will also apply to recredentialing and revalidation, and ODM is working to coordinate recredentialing dates with the MCEs.  Providers will need to be credentialed when they initially enroll with Medicaid and then every 36 months.

One important factor to note is that, if a practice is contracted with plans other than Medicaid with the insurance companies that are also MCEs, applications will still need to be submitted to get the providers credentialed for those plans. For example, if a practice is contracted with CareSource for plans other than Medicaid, the ODM credentialing will not apply to these non-Medicaid plans.  The practice would need to submit a separate application for each provider to CareSource to be credentialed directly for these non-Medicaid CareSource plans.

ODM will be releasing more information about centralized credentialing and the new PNM system as the implementation date approaches.  In the meantime, additional information can be found on the ODM website, as well as direct email addresses for questions regarding centralized credentialing and the PNM system.

Jessica Roe is a Credentialing Manager at Medic Management Group. She has worked with credentialing clients in 16 states across various specialties, including PCPs, Behavioral Health Providers, Dentists, Audiologists, and Hearing-Aid Suppliers, among others. In her day-to-day work at MMG, Jessica supports solo practices, group practices, federally qualified health centers, hospital-based providers, and urgent care centers. MMG is a national provider of consulting services and back office administrative support to independent and system owned physician practice groups.  Additionally, MMG has been formally recognized as a multi-year Northeast Ohio Top Workplaces award winner.

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