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WELCOME to our first newsletter!
AmeriHealth Caritas is a national leader in providing managed care solutions and comprises one of the largest families of Medicaid companies in the United States. With our mission-driven legacy of 40 years, we’re more than just another health insurance company. Every day, we put care at the heart of our work for our members, their families, and our providers.
AmeriHealth Caritas Ohio encourages and supports a holistic approach to healthcare. Together we will help Ohioans get care, stay well, and build healthy communities by addressing the acute and broader social factors that drive health outcomes.
Our emphasis on provider support
At AmeriHealth Caritas, we are dedicated to ensuring our participating providers have the information and assistance they need to partner with us and provide quality care for our members. Our approach includes the following:
- Assigned, local Account Executives
- Ongoing education
- Provider committees
- Searchable online tools
- Excellent customer support
- Consistent plan-to-provider communication
For more information about becoming an AmeriHealth Caritas Ohio provider, click here.
Look for our monthly newsletter and timely updates as needed.
The best partnerships are formed by staying in touch
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AmeriHealth Caritas Ohio Provider Orientation
In September, you will receive an invitation for you and your office staff to join us for a provider orientation. These orientations are designed to familiarize you with not only the vast resources available to you through our website, but also identify areas of importance to help you work with us to best serve our members — your patients. You can attend either virtually or in-person.
If you want to sign up before receiving the invitation, click here. |
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Large Group/In-person
10 a.m. - noon or 1 - 3 p.m. |
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Lucas County Public Library
501 River Road, Maumee |
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The Centers
4500 Euclid Avenue |
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Deer Park Library, Meeting Room A
4020 E. Galbraith Road
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Columbus Metropolitan Library Auditorium
96 S. Grant Avenue |
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Athens Community Center
701 E. State Street |
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Engineers Club
110 E. Monument Avenue
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Virtual Orientation via Zoom (link coming soon)
10 - 11 a.m. |
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Sept.20
Oct. 4
Oct 18
Nov. 15
Nov. 29
Dec. 13
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OhioRISE Provider Enrollment During System Transition |
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In preparation for the Oct. 1 launch of the new Provider Network Management (PNM) module, which will reduce administrative burden on providers, the Ohio Department of Medicaid (ODM) stopped accepting new provider enrollment applications through the MITS Provider Enrollment System Aug.1.
In recognition of the ongoing enrollment of OhioRISE members and the needs to support and build the system of care related to the July 1 |
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launch of the OhioRISE program, ODM and Aetna Better Health of Ohio (Aetna) partnered to develop a process for use during this time. Organizational or individual practitioners who will be providing OhioRISE services can be screened for enrollment so that they can provide and bill for services. Currently enrolled Medicaid providers will also be able to add OhioRISE specialties during the provider enrollment system downtime. |
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OhioRISE Child and Adolescent Needs and Strengths (CANS)
The CANS assessment is a support tool in the clinical decision-making process to determine eligibility into OhioRISE and level of care and service planning. The Ohio CANS assessment tool has been developed for broad application across multiple systems, including youth involved in child protection, developmental disability, department of youth services, and mental health and addiction. This ensures youth only need to go through one assessment across multiple providers. The tool gathers all dimensions of the youth and family story to determine needs and strengths and integrates multiple storytellers capturing the voice of the youth and family to produce a full consensus-based assessment. The CANS assessment tool is updated routinely over the course of treatment to continue ongoing care planning.
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Next Generation of Ohio Medicaid Managed Care Implementation
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The Ohio Department of Medicaid is introducing its Next Generation managed care plans to focus on the individual, honor members’ choice, and provide continuity in the provision of members’ care. These changes do not apply to MyCare. |
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The Next Generation of Ohio Medicaid program will be implemented in stages to avoid unnecessary disruption and confusion for members and to reduce burdens on our service providers. The Next Generation program will be implemented in the following stages:
Stage 1: On July 1, 2022, OhioRISE started providing specialized services, which will help children and youth with behavioral health needs and help coordinate care for those who receive care across multiple systems.
Stage 2: On Oct. 1, 2022, Centralized Provider Credentialing will begin which will reduce administrative burden on providers. Also, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members.
Stage 3: On Dec.1, 2022, the implementation of the Next Generation managed care plans will occur. Members will experience benefits that help address their individual health care needs such as increased access to care coordination and care management supports. Also in stage three, ODM will implement additional improvements to streamline the process of claims and prior authorization submission for providers.
Ohio Medicaid members currently receiving healthcare benefits through Paramount Advantage will continue to receive healthcare benefits through that plan until stage 3 of the implementation of Next Generation managed care plans. Unless a member chooses another plan by stage 2, they will be enrolled with Anthem Blue Cross and Blue Shield in stage 3 of the implementation process. Current Paramount members can select a different plan at any time during the member transition and enrollment period.
In stage 3, the members in this group who are eligible for a managed care plan will be assigned to a Next Generation plan by ODM and will begin receiving services from that plan. ODM will notify impacted members which plan they have been assigned to, and members can select a different plan at any time now through Nov. 30, 2022.
You can read more about Next Gen here.
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Need help navigating all the changes?
Reach out to AmeriHealth Caritas Ohio provider services at 1-833-644-6001 or the Ohio Department of Medicaid provider hotline at 1-800-686-1516. We’re here to help! |
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Next Generation Program - Provider Updates for October 1 Launch
On October 1, the Ohio Department of Medicaid (ODM) will launch the Provider Network Management (PNM) module and Centralized Credentialing, which will reduce administrative burden on providers. At the same time, the Single Pharmacy Benefit Manager (SPBM) will begin providing pharmacy services across all managed care plans and members.
To prepare for these changes, providers should set up their OH|ID and associate their existing accounts. The OH|ID pre-registration site is available through September 23 and can be found at: https://pnm-preregistration.omes.maximus.com. The OH|ID is necessary for anyone that will access the PNM or SPBM modules. Establishing login credentials during pre-registration will ease the transition and prevent disruptions to system access for providers ahead of the October 1 launch.
In preparation for the launch of the PNM and SPBM, ODM is offering a variety of trainings. These trainings are a great opportunity for providers to gain knowledge that will benefit our members!
PNM Trainings
ODM is offering several PNM training opportunities. Using the Learning Management System (LMS), Absorb, providers will be able to access self-paced training sessions and sign up for virtual and/or in-person learning. It is important that providers create an account in the LMS to secure access to all training sessions, answer forms, and PNM resources in advance. Trainings will cover topics including: PNM login and access, system navigation, new enrollment applications, demographic updates, and revalidations.
SPBM Trainings
Several SPBM training opportunities will be offered beginning September 6. Training is offered via online instructor-led webinars, recorded online training, and weekly Q&A forums. Registration for training is now open. Registration instructions are available by navigating to https://spbm.medicaid.ohio.gov and selecting the Provider tab. Trainings will cover topics including: SPBM login and access, system navigation, verifying member pharmacy benefit eligibility, submitting and viewing pharmacy claims and submitting and viewing pharmacy prior authorizations.
Need Help?
To learn more about the PNM module and Centralized Credentialing, visit the PNM & Centralized Credentialing site and Single Pharmacy Benefit Manager (SPBM) webpages. For questions about the Next Generation program, contact ODMNextGen@medicaid.ohio.gov.
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Visit the Provider section of the AmeriHealth Caritas Ohio website for more information, news and resources. If you need assistance, please contact your assigned Account Executive.
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