Effective October 20, Next Generation Medicaid managed care organizations (MCO), the OhioRISE plan, and MyCare Ohio plans, must use provider data from Ohio Medicaid’s Provider Network Management (PNM) module as it is the official system of record. To ensure the provider data sent from the PNM to the managed care entities (MCE) is accurate and up to date, it is imperative that your records are updated within the PNM daily. If your data in the PNM module does not match your data on the submitted claim, your claims will be denied for payment.
Actions needed by you as a provider or a trading partner
- Check that all data submitted on a claim and within the PNM module (e.g., addresses, affiliations, specialties, locations) is accurate and up to date.
- Access Provider Education & Training Resources within the PNM ‘Learning’ tab for step-by-step instructions.
- Continue to update data as changes occur. MCEs will use this information as the system of record moving forward.
The MCEs download a complete extract of the Provider Master File (PMF) daily that includes all provider data.
You can read the full announcement here.