Urgent – Is your data current? Provider network management and centralized credentialing from ODM

As part of the Next Generation of Ohio Medicaid Managed Care (OMMC), the Ohio Department of Medicaid (ODM) has contracted with Maximus, Inc.,* a National Committee for Quality Assurance (NCQA)-accredited credentials verification organization (CVO), to complete certain credentialing-related tasks. ODM began centralized provider credentialing as part of the Next Generation of OMMC on October 1, 2022, the same day ODM launched the provider network management (PNM) website. The PNM website is a modular component of the Ohio Medicaid Enterprise System (OMES) for providers to complete various functions including, but not limited to, enrollment, credentialing, group affiliations, and updating demographics.

ODM has mandated that managed care entities (MCEs) use their data as their source of truth by
October 20, 2023, so it is imperative that providers enroll, credential, and always maintain current data in ODM’s PNM website as Anthem Blue Cross and Blue Shield (Anthem) receives provider data directly from ODM. It is very important to ensure your enrollment and credentialing tax ID with ODM coincides with your Anthem provider contract. With the Next Generation of OMMC, ODM’s data is the source of truth. Failure to do so will result in incomplete or inaccurate data in Anthem systems causing potential issues/delays or denials with authorizations, claims, and more.

Providers must create an Ohio ID prior to registering in the PNM website in order to be eligible for reimbursement. To begin this process, visit https://ohid.ohio.gov/wps/portal/gov/ohid/create-account/create-account. If you need assistance or experience technical issues, contact the ODM Help Desk at 800-686-1516 or visit IHD@medicaid.ohio.gov.

If you already have an OH ID, you can log into the PNM website by visiting https://ohpnm.omes.maximus.com/OH_PNM_PROD/Account/Login.aspx. For assistance with the PNM, website, contact the ODM Help Desk at 800-686-1516, select option 2, then select option 3 to speak to a live agent.

More information about the Next Generation of OMMC can be found at https://managedcare.medicaid.ohio.gov/providers/about-next-gen-program.

A FAQ for ODM centralized credentialing questions can be found at https://managedcare.medicaid.ohio.gov/static/PNM/Centralized-Credentialing-FAQ.pdf.

Information regarding the NCQA can be found at https://www.ncqa.org/.

If you have questions for Anthem, please contact your dedicated provider relationship account manager or email OhioMedicaidProvider@anthem.com.