In preparation for the October 1, 2022, launch of the new Provider Network Management (PNM) module, ODM stopped accepting new provider enrollment applications through the MITS Provider Enrollment System effective August 1, 2022.

In recognition of the unique enrollment needs of community behavioral health (BH) and other OhioRISE providers that may be onboarding new staff during this transition period, ODM, the Medicaid Managed Care Organizations (MCOs), and the OhioRISE plan have partnered to develop a limited special enrollment process for provider types 84 and 95 available until September 30, 2022. This process will allow new community BH and OhioRISE practitioners to be screened for Medicaid enrollment so organizations can begin billing Medicaid MCOs, the MyCare plans, and the OhioRISE plan for services before the new PNM is launched and the full enrollment process can be completed.

The process is optional and intended to assist providers for whom a delay in enrolling new staff in Ohio Medicaid may cause BH services access concerns. Providers may elect to wait until after October 1, 2022, to initiate new practitioner enrollment in the PNM.

This guidance replaces previous guidance about OhioRISE Provider Enrollment During System Transition issued by ODM effective August 31, 2022.

Provider Eligibility for Special Enrollment During Transition

This special enrollment process is limited to the enrollment of new individual practitioners affiliated with an existing community BH provider type 84 (mental health agency) or type 95 (substance use disorder treatment agency) and providers enrolling because they intend to provide services to OhioRISE enrollees.

This process is NOT available to any of the following:

• Providers that have already requested OhioRISE Provider Enrollment During System Transition through Aetna OhioRISE.
• Individual practitioners not affiliated with Ohio Medicaid provider types 84 or 95 or those practitioners who are not enrolling to provide services to OhioRISE plan enrollees.
• Except for specialties specific to new services affiliated with the OhioRISE program, practitioners that are currently enrolled and affiliated with a provider type 84 or 95 that are seeking to add or change a practitioner specialty.
  • See instructions for OhioRISE provider specialty additions on pages 3 and 4.
• Practitioners that have criminal convictions to disclose.
  • The screening for such instances requires background checks and deeper review of exclusionary periods that cannot be accommodated with this special process.
  • These providers should submit a new application for enrollment on or after October 1, 2022, in the new PNM system. However, the effective date can be backdated for up to 12 months from the application date and NPI enumeration date as long as the relevant provider criteria are met.
•  Providers who only are seeking to bill Medicaid fee-for-service.

Guidelines for Temporary Enrollment

Eligible providers seeking to use the temporary enrollment process proceed as follows:

1. Providers complete paper applications using forms ODM 05160 and ODM 10283. All paper applications must be completed on the ODM 05160 form and the accompanying ODM form 10283 (provider agreement) must be signed by the applicant. These forms should be submitted by email to the PE mailbox ([email protected]) using the subject line “BH and OhioRISE provider special enrollment.”
2. ODM will review the application for completeness and verify the applicant is not excluded from participation per state and federal requirements. Please note:
   1. ODM will not be able to manually enter the applicant in the system from August 31 – September 30, 2022, so the provider will not appear in MITS and will not yet have a Medicaid ID in MITS.
   2. ODM will be approving the provider on paper for the MCOs, MyCare plans, and OhioRISE plan to accept as rendering providers. Once the provider is approved, ODM will send that provider’s information in a supplemental spreadsheet to the MCOs, MyCare plans, and OhioRISE plan each week for integration in their claims system beginning September 8. MCOs, MyCare plans, and the OhioRISE plan will upload the information from the supplemental file into their system within three business days.
   3. Until September 30, 2022:         
      1. If the applicant successfully passes screening, the provider will be notified via email. The provider’s information will be added to a supplemental file that will be shared with the MCOs, MyCare plans, and the OhioRISE plan on a weekly basis beginning September 8. MCOs, MyCare plans, and the OhioRISE plan will upload the information from the supplemental file into their system within three business days.
      2. Providers may submit claims to the relevant MCO, MyCare plan, and the OhioRISE plan upon addition to the MCO, MyCare plan, and/or OhioRISE plan’s network.
      3. If the provider does not successfully pass screening, ODM will issue appropriate notice with due process rights to the provider.
      4. Beginning October 1, 2022:
         1. ODM will manually enroll the providers screened using the temporary process in the PNM (with a backdated effective date to match the application date or the NPI enumeration effective date) and issue the welcome letter and the Medicaid Provider ID.

Please note that effective Oct. 1, 2022, all new provider enrollment applications, and requests to add new specialties must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) module. After its implementation, the PNM module will be the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service updates.

For questions about this process, please reach out to [email protected] and include “BH Special Enrollment” in the subject line or contact ODM’s Integrated Help Desk (IHD) at 800-686-1516 Monday through Friday 8 a.m.-4:30 p.m. and follow the prompts to Provider Enrollment.