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October 31, 2023
November 2023 Managed Care Plan Updates

This past month, the managed care plans have published updates on events and policy changes impacting their organizations.

CareSource Update: 

  • Provider Network Management (PNM) Module Update: Effective October 20, Next Generation Medicaid managed care organizations (MCO) 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, it is imperative that your records are updated within the PNM module. If your data in the PNM module does not match your data on the submitted claim, your claims will be denied for payment. Click here to read more about this update.

 

AmeriHealth Caritas Update:

  • New Form Required When Requesting an Administrator Change Across Organizations: Ohio Department of Medicaid (ODM) developed a new form, ODM10304, that must accompany requests to change Provider Network Management (PNM) Administrators from one billing organization provider to another. As a security measure, you must submit a formal request to transfer Administrator ownership of a Medicaid ID within the PNM module. More details are available on ODMs website.
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