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Ohio Health Plans Launch Pathways for Pharmacists to be Reimbursed as Providers
Ohio pharmacists practice in one of the few states where they are recognized as providers and can be reimbursed for their clinical services. Now that this huge practice transformation opportunity is available, Ohio pharmacists can take the next step of implementing provider status-related services – receiving a Medicaid ID number to allow compensation for services.
As we announced earlier this year, in an important step in the implementation effort, the Ohio Department of Medicaid became the latest of a small number of states that began enrolling pharmacists as providers by enabling the procurement of provider ID numbers within their program. Since the enrollment opened in January 2021, more than 400 pharmacists have signed up and have acquired their Medicaid provider ID number. This is an exciting milestone in our effort to enhance value to pharmacy practices, realign incentives, and improve access to patient care.
After obtaining a Medicaid ID number, pharmacists can begin direct engagement with Medicaid managed care organizations (MCOs) and MyCare plans, which cover patients with dual Medicare and Medicaid eligibility. At this time, all Medicaid MCOs and MyCare plans within the state have opened up opportunities to any pharmacist with a Medicaid ID number to contract, allowing for reimbursement for pharmacist-led provider status services.
After years of ups and downs with insurers, it is remarkable that despite the barriers and hassles encountered in provider status efforts in other states, all the MCOs and MyCare plans recognize the value of pharmacists and are compensating them for that value. This is nothing short of incredible and shows Ohio’s leadership for pharmacist provider status initiatives.
For FAQs and guidance about provider status and how to obtain your provider ID, requirements for billing, visit the OPA provider status page here. See the following links for more details on onboarding with each of the Medicaid MCOs and MyCare plans:
Paramount: Pharmacists who are a contracted provider group practice or facility with Paramount Advantage should be submitted to Paramount as an addition to the group’s provider roster. The Provider Information Roster is available on Paramount’s website: https://www.paramounthealthcare.com/services/providers/tools-and-resources/documents-and-forms.
If the pharmacist is not contracted, fill out and return a Network Participation Request Form, available on Paramount’s website: https://www.paramounthealthcare.com/services/providers/. Click on Join Our Network, and Network Participation Request form. The address for return is on the form itself, which is phcprovider.contracting@promedica.org
United Healthcare Community Plan
Aetna MyCare: Email oh_contracting@AETNA.com to begin the contract process.
“This is the start of a new era for pharmacy in the state of Ohio,” says Stuart Beatty, Associate Professor of Clinical Pharmacy at The Ohio State University College of Pharmacy and Director of Strategy and Practice Transformation at Ohio Pharmacists Association. “Through provider status efforts, we are creating a pathway to incentivize pharmacists for optimizing medications and working as part of the broader health care team to provide the best care possible for our patients. Obtaining a Medicaid ID number and enrolling with payors will allow pharmacists to be reimbursed for any Medicaid or dual-eligible patient in the state of Ohio needing care. This is a huge opportunity to transform practice, create a sustainable business model, and demonstrate the value pharmacists provide.”
OPA is here to support pharmacists in taking this next step and has worked with the Ohio Department of Medicaid (ODM) and the MCOs to create a FAQ document and a tip sheet on how to enroll and contract for payment. Pharmacists are poised to positively transform healthcare in Ohio through provider status. Take the first steps of acquiring a Medicaid ID and contracting with payors to begin the process! Please contact Stuart Beatty at sbeatty@ohiopharmacists.org for further questions and guidance.
