If you offer medical services and want more information about becoming a participating provider, please submit the following information when completing the New Health Partner Contract Form. Some providers will be asked to provide additional information, to comply with new ACA disclosure requirements. check your deductible, change your The Independent Provider Initial Training course is available on DODD MyLearning. (See OAC 5160-1-17.8 formerly OAC 5101:3-1-17.8 for additional information about provider screening requirements). Enrollment with Ohio Medicaid is required for both fee-for-service and managed care participation and payment. Transportation can be used for community . NET Requests must be submitted five days before transportation is needed. Claims submitted via trading partners are not viewable within the PNM module; however, providers can work with their trading partner to view a claim status. Local Business License, Tax Certificate, and . They may also be faxed to 419-213-8820. Note: A Social Security Number (SSN) is required by State and Federal law of all individuals applying to obtain a Medicaid provider number. For additional questions you may call 419-213-8910. On-site screening visits are conducted without prior notification or appointment. Non-Medical Transportation includes transportation to get to, from, between, or among: A place of employment The web-based application will take you through a series of screens depending on your provider type. The changes we make will help you more easily access information, locate health care providers, and receive quality care. Through this link, providers will be able to submit and adjust fee-for-service claims, prior authorizations requests, hospice applications, and managed service providers/hospital/long term care cost reports. For help or to check if you are eligible for unlimited rides, call (866) 642-9279. Some providers may be required to submit additional documentation as a part of their revalidation process. After three documented outreach attempts over at least a thirty-day period, MCOs may deny claims for providers who fail to enroll with ODM. Click here to view the OhioRISE Provider Enrollment and Billing Guidance. Double check your requirements with your local bureau of motor vehicles, and make sure you understand any standards set for Medicaid transportation if you offer it, like: Number of penalty points on a driving record A certification of the driver's health A vehicle liability insurance policy A criminal background check The provision in 42 CFR 438.602(b) does not require providers to render services to FFS beneficiaries. 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. Contact your MAC (PDF). If you're asked to log in with an OHID - the state's best-of-breed digital identity - your privacy, data, and personal information are protected by all federal and state digital security guidelines. 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. If you're asked to log in with an OHID - the state's best-of-breed digital identity - your privacy, data, and personal information are protected by all federal and state digital security guidelines. Entering an invalid SSN or entering a FEIN in the place of a SSN may result in the rejection of your application. The Ohio Department of Medicaid (ODM) provides health care coverage to more than 3 million Ohioans through a network of more than 165,000 providers. These changes provide Ohio Medicaid managed care members enhanced healthcare services that best fit their individual healthcare needs and streamline claims and prior authorizations for providers. Your Portal Administrator has the role to view these reports. To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days: You must report all other changes within 90 days. The changes we make will help you more easily access information, locate health care providers, and receive quality care. Amodified vehicle must be equipped with a stable access ramp specifically designed for wheelchairs or a hydraulic lift specifically designed for wheelchairs; On each day the vehicle is used to provide Non-Medical Transportation, the first driver of the vehicle shall conduct and document inspection and testing of the wheelchair fasteners, restraints, and access ramp or hydraulic lift prior to transporting a person in a wheelchair. You may request the effective date of your Medicaid provider enrollment to be retroactive up to twelve months prior to the application submission date. NPI number. If you are an existing user with an assigned administrator or agent role in the PNM, please note that the New Provider button is only available for administrators and not agents. Yes., A provider can request retroactive enrollment up to 365 days, according to Ohio Administrative Code rule 5160-1-17.4. The ODM will verify the submitted information and in some instances, conduct an on-site visit. (See Provider disclosure requirement) OAC 5160-1-17.3 ). If you're asked to log in with an OHID - the state's best-of-breed digital identity - your privacy, data, and personal information are protected by all federal and state digital security guidelines. Below is an outline of what's needed: Register your business with the state Obtain the proper insurance coverage Get your vehicles inspected and approved Complete any necessary training Apply to become a Medicaid provider Let's look at each in some detail. Learn more about Ohio's largest state agency and the ways in which we continue to improve wellness and health outcomes for the individuals and families we serve. Please select ONE transportation contractor. Other types of payment will not be accepted. You can apply for an NPI on the NPPES website. Providers must disclose the information for owners (direct and indirect), members of Boards of Director and managing employees this information includes an individuals Social Security number and date of birth. The fee is a federal requirement described in 42 CFS 445.460 and in OAC 5160:1-17.8. CMS-20134 (PDF) for MDPP Suppliers. All three of the above forms are needed to apply for Non-Emergency Medical Transportation. You may also visit OAC 5161-1-17.4 for additional information on the revalidation requirement and process. Learn more about Ohio's largest state agency and the ways in which we continue to improve wellness and health outcomes for the individuals and families we serve. Do providers that have revalidated with Medicare also have to revalidate with Ohio Medicaid? 5160-15-23 Transportation: services from an eligible provider: ground ambulance services. Provide registration of your vehicle (s). Your next steps could include uploading or submitting additional documentation necessary for enrollment. Whenever possible, family, friends, neighbors, or community agencies that provide transportation without charge should be used first. In Ohio, the Public Consulting Group, Inc. (PCG) will conduct these visits for providers that are not already screened by another state or federal agency. This new process will provide ODM continuous information about a persons criminal history. We are streamlining provider enrollment and support services to make it easier for you to work with us. and develop and implement written policies and procedures regarding vehicle accessibility, vehicle maintenance, and requirements for vehicle drivers. This means that any provider an MCO has listed as a network provider must be active in ODMs Medicaid Information Technology System (MITS). This can usually be done online or by mail. Share sensitive information only on official, secure websites. If you are interested in becoming an operator, please contact the CTC for that county. NEMT services include ambulatory, wheelchair . 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. Toreceive payments via direct deposit, please complete theDirect Deposit Authorization Agreement, which can be found by clicking on the "Medicaid Provider" tab. Transportation services may be availablebased on an understanding of a person's needs discovered during an assessment, then listed in their individual service plan. Reporting Abuse/Neglect. If you are unsure of what provider type to request, you should contact the Integrated Help Desk at1-800-686-1516 for additional information on additional resources that can help you make this determination. After you have entered your basic demographic information, the system will issue you aRegistration ID. Not sure if you have an NPI? Do I need to enroll with ODM to be contracted with an MCO? How are MCOs enforcing this federal requirement? For Passport or Assisted Living waiver programs (Ohio Department of Aging). Effective Oct. 1, 2022, providers will utilize the new Provider Network Management Module (PNM) to access the MITS Portal. This is required for any company that operates vehicles for interstate commerce. Your W-9 tax form. Your MAC can help you navigate the enrollment process and answer questions about your application. Providers will receive a separate notice for each provider number. If you're asked to log in with an OHID - the state's best-of-breed digital identity - your privacy, data, and personal information are protected by all federal and state digital security guidelines. Since you plan to provide transportation services, you will also need to obtain a DOT number from the Department of Transportation. Once you have completed the application, the system will provide information regarding next steps. This is typically used in conjunction with homemaker personal care services to get to and from activities with a provider. Copyright CareSource 2023. This guide will help you enroll in three steps. For additional information, please visit: https://managedcare.medicaid.ohio.gov/providers. Read on if you are looking for information specific to our current programs. The fee applies to organizational providers only; it does not apply to individual providers and practitioners or practitioner groups. It guides how we operate our programs and how we regulate our providers. The fee to Ohio Medicaid will not be required if the revalidating organizational provider has paid the fee to either Medicare or another states Medicaid provider enrollment within the past two years. The PCG representatives will have a business card and a letter of introduction, for your verification. The system will then ask you to provide basic demographic and identifying information along with your provider type selection. On the next screen you will be asked to select your application Type. The partnership between Ohio Medicaid and its provider network is critical in ensuring reliable and timely care for beneficiaries across the state. If you're asked to log in with an OHID - the state's best-of-breed digital identity - your privacy, data, and personal information are protected by all federal and state digital security guidelines. Providers wanting to view or edit a claim, must use the same system that was used for the original submission. means youve safely connected to the .gov website. Transportation authorization may be in the form of bus passes, van services, Access tickets or mileage reimbursement. Visit our TradingPartners page to learn more. Call at least 2 business days before your visit. Whoever knowingly and willfully makes false statements or representations on this application may be prosecuted under applicable federal or state laws. Once you select the registration id link you will be taken to the Provider Management Home page. tree, then press Insert+Spacebar to switch to forms/focus mode. Providers, trading partners, and managed care entities will not directly interact with the FI. The process lasts around three weeks but can take longer depending on the state where your business is located. To assist waiver providers in complying with this requirement, please review the following documents found atop this page. Share sensitive information only on official, secure websites. Please call Provider Services at 1-866-296-8731. An Ohio.gov website belongs to an official government organization in the State of Ohio. Read on if you are looking for information specific to our current programs. The cost is typically around $200 but may be more or less depending on your state. 5160-15-13 Transportation: non-emergency services through a CDJFS: administration. It guides how we operate our programs and how we regulate our providers. However, if you are an individual that wants to provide Ohio Department of Medicaid waiver services to someone living in their own home you should select Medicaid Waiver (ODM). Its important to keep your enrollment information up to date. The requirement to accept a properly executed form is applicable within 30 days of January 3, 2019. OhioRISE Provider Enrollment and Billing Guidance, National Provider Identifier Requirements ODM Letter for Waiver Providers (September 2020), National Provider Identifier and Taxonomy Guidance for Providers of Department of Developmental Disabilities (DODD) Waiver Services (September 2020), National Provider Identifier and Taxonomy Guidance for providers of Ohio Department of Aging (ODA) Waiver Services (September 2020), National Provider Identifier Reference Guide, the Ohio Childrens Initiative Child and Adolescent Needs and Strengths (CANS) Information Technology (IT) System, https://aging.ohio.gov/wps/portal/gov/aging/agencies-and-service-providers/certification, https://dodd.ohio.gov/wps/portal/gov/dodd/providers/initial-renewal-certification/certification-recertification. For Individual Options, Level 1 and SELF waivers (Ohio Department of Developmental Disabilities) - Visit the DODD Gateway: Federal and state regulations require all Medicaid providers to disclose full and complete information regarding individuals or entities that own, control, represent or manage them. Sign up to get the latest information about your choice of CMS topics. In order to become an Ohio Medicaid Provider, you must complete a web-based electronic application. . The Ohio Department of Medicaid (ODM) provides health care coverage to more than 3 million Ohioans through a network of more than 165,000 providers. Once approved, youll be able to start providing transportation services to Medicaid recipients!