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News from the Ohio Department of Medicaid

OPM 2022 Press | September 22, 2022


OPA Member Notice from Ohio Department of Medicaid regarding the Provider Network Management (PNM) system

 

Pre-Register for PNM Through September 23!

Providers have through Friday, September 23, to pre-register for the PNM module ahead of the PNM launch on October 1. As a reminder, an OH|ID is required to access the PNM module. Access to key administrative functions could be delayed for providers who do not pre-register. If providers are unable to take advantage of pre-registration, they will still be able to access the PNM and setup their account at go-live October 1. 

To access the PNM pre-registration site, please direct providers to https://pnm-preregistration.omes.maximus.com.  

If providers need technical assistance or encounter an error while pre-registering, please direct them to contact the ODM Integrated Help Desk Command Center at 1-800-686-1516, option 8. For more information on PNM pre-registration or the PNM module, please visit the PNM & Centralized Credentialing page on the ODM Managed Care site. 


Pharmacists: Updated Provider Manual

Beginning October 1, pharmacy benefits for Medicaid managed care members will be covered by the Single Pharmacy Benefit Manager (SPBM), Gainwell Technologies. Gainwell’s provider manual, also known as the pharmacy reference guide, is the primary resource guide providing key information to pharmacy providers, pharmacy support staff, and prescribers. The provider manual includes information related to pharmacy claims submission, reimbursement rates, pharmacy network requirements, the specialty pharmacy program, claims processing, utilization management, and prior authorization. 

How Do I Access the SPBM Provider Manual? 

The provider manual can be found here and on ODM’s Next Generation website under Provider Manual. The provider manual is updated periodically to reflect program changes or clarifications as necessary.  

For additional information about SPBM please visit ODM’s Next Generation website or the Gainwell Ohio Pharmacy website


Single Pharmacy Benefit Manager (SPBM) Training

The Gainwell Ohio SPBM training staff would like to remind pharmacists, and pharmacy support staff that it is not too late to register for SPBM Web Portal training! 

Please join us to learn the difference between the public and the secure portals, including how to register for the latter. The public facing SPBM Web Portal provides instant access to reference material such as the Unified Preferred Drug list (UPDL) and criteria, the Preferred Diabetic Supply list, the Specialty Drug list, and Quantity Limits list to assist with prescribing medications to Ohio Medicaid Managed Care members. 

The secure SPBM Web Portal requires credentials wand provides a way for users to check eligibility of Ohio Medicaid managed care members, the ability for prescribers and designated support staff to submit prior authorizations, the ability for pharmacies to submit claims, users to view claim and prior authorization history, and a secure web chat to quickly speak with the SPBM help desk.

Registration instructions can be found by navigating to https://spbm.medicaid.ohio.gov and selecting the provider tab. Under the provider tab, you will find the associated menu for “SPBM Web Portal Training.” Training began September 19 for pharmacists and pharmacy support staff. 

If you are unable to attend one of the live instructor-led webinars, it is still important to register for the Gainwell Ohio Learning Management System (LMS) so that you will have access to the recorded training. Once the recorded training is available on the Gainwell Ohio LMS, an announcement will be placed in the “Announcement” area of the SPBM web portal’s home page. Please note, the SPBM and PNM trainings utilize separate LMS systems and providers should register for both.

If you have any questions regarding SPBM web portal training, please email OH_MCD_PBM@gainwelltechnologies.com.


Registration is open for Provider Network Management (PNM) Training!

As you are likely aware, Ohio Medicaid is in the process of implementing our Next Generation program to focus on the individual rather than the business of managed care so that we can do better for the people we serve. One way we hope to achieve this vision is through the implementation of the Provider Network Management (PNM) module to reduce the administrative burden on providers.

Training and Learning Management System

In preparation for October 1, we are offering a variety of training options including self-paced, virtual, and in-person training options. Absorb, the Learning Management System (LMS), is where you will access the self-paced training and sign up for the virtual and/or in-person sessions.

PNM LMS Registration

It is important that you create an account in the PNM LMS to ensure you have access to all training sessions, answer forms, and PNM resources in advance. Please note, the SPBM and PNM trainings utilize separate LMS systems and providers should register for both. Click on the appropriate link below, based on your provider type, to access the PNM LMS and follow the steps to create your account and register for training: 

Provider Group

Enrollment Key

Enrollment Key Link

Individual Providers

individualprovider

www.ohiopnm.myabsorb.com?KeyName=individualprovider

Group/Organization Providers

grouporgprovider

www.ohiopnm.myabsorb.com?KeyName=grouporgprovider

Hospital Providers

hospitalprovider

www.ohiopnm.myabsorb.com?KeyName=hospitalprovider

Facility Providers

facilityprovider

www.ohiopnm.myabsorb.com?KeyName=facilityprovider

Behavioral Health Individual Providers

bhindividualprovider

www.ohiopnm.myabsorb.com?KeyName=bhindividualprovider

Behavioral Health Organization Providers

bhorgprovider

www.ohiopnm.myabsorb.com?KeyName=bhorgprovider

DODD Waiver Providers

doddwaiverprovider

www.ohiopnm.myabsorb.com?KeyName=doddwaiverprovider

DODD Non-Medicaid Providers

doddnomedprovider

www.ohiopnm.myabsorb.com?KeyName=doddnonmedprovider

ODA Waiver Providers

odawaiverprovider

www.ohiopnm.myabsorb.com?KeyName=odawaiverprovider

ODM Waiver Providers

odmwaiverprovider

www.ohiopnm.myabsorb.com?KeyName=odmwaiverprovider

Questions

Please email OhioTrainingTeam@maximus.com with any questions regarding training sessions or additional information.

About the PNM and Centralized Credentialing

The PNM module and Centralized Credentialing program are part of the strategic initiatives being implemented within the Next Generation of Ohio Medicaid’s managed care program.

The PNM will replace the current Medicaid Information Technology System (MITS) provider enrollment subsystem provider portal. This module will be implemented along with Centralized Credentialing, which is a state-level single centralized provider credentialing process. These initiatives will modernize the system by streamlining processes and reducing administrative burdens for providers. For more information about PNM and Centralized Credentialing, visit the Managed Care website.

Thank you in advance for your consideration and for your support of ODM’s Next Generation vision.


Provider Enrollment and Maintenance Blackout Dates

Important changes that may impact you as an Ohio Medicaid (ODM), Department of Developmental Disabilities (DODD), or Ohio Department of Aging (ODA) provider are coming, and we want to make sure you’re aware of them.  

The Ohio Department of Medicaid (ODM) has temporarily paused all provider enrollment and maintenance activities during this transition. On October 1, provider enrollment and maintenance-related activities will resume and be submitted using PNM. Organizational or individual practitioners who will provide services covered by the OhioRISE program and behavioral health community providers may enroll with Medicaid and add OhioRISE provider specialties between August 1 and September 30 to begin providing and billing for services. The guidance was updated on August 31, please view the Updated Community BH and OhioRISE Provider Enrollment During System Transition for direction on this process.  

For more information about PNM and trainings, please visit:

www.managedcare.medicaid.ohio.gov/managed-care/centralized-credentialing 

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