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Update on Provider Network Management Module and Fiscal Intermediary Projects

Go-live dates for Ohio Department of Medicaid Provider Network Management Module, Centralized Credentialing, and Fiscal Intermediary Projects

After undergoing a timeline review to ensure optimum testing and readiness, the Ohio Department of Medicaid (ODM) along with the Department of Developmental Disabilities (DODD) and Ohio Department of Aging (ODA) will undertake a phased approach and go-live for the Provider Network Management (PNM) module, Centralized Credentialing, and Fiscal Intermediary (FI) projects. The anticipated go-live dates for each phase are:

PNM & Centralized Credentialing - Phase 1 (July 26, 2021)

  • One Front Door provider enrollment
  • Provider credentialing
  • Provider self-service (demographic updates, group affiliations)
  • Enhanced provider directory

PNM Portal Functionality - Phase 2 (December 20, 2021)

  • Claim submission (fee-for-service) / searches 
  • Prior authorization submission / searches
  • Member eligibility verification
  • Hospice member functions

FI Go-live (December 20, 2021)

  • Fee-for-service claims adjudication
  • Fee-for-service prior authorizations
  • Clearinghouse functionality
  • Encounter processing 
  • Payment processing
  • Cost report submission / searches

ODM and state sister agencies will continue to provide regular updates to keep all stakeholders informed of important training opportunities, additional details regarding Phase 1 and Phase 2 deliverables, and current system cutover dates as they become available.

For additional information about these initiatives, visit the following pages on the managedcare.medicaid.ohio.gov website: 

PNM & Centralized Credentialing

Fiscal Intermediary

Questions can be sent to the following email boxes:

Background on the PNM, Centralized Credentialing & FI initiatives:

Provider Network Management (PNM) Module

The PNM module is part of the ODM system modernization initiative that was developed in accordance with the Centers for Medicare and Medicaid Services (CMS) guidance to transition to a modular system called the Ohio Medicaid Enterprise System (OMES). PNM ultimately will replace the MITS provider enrollment subsystem and the current MITS provider portal. This will enable all Medicaid providers, regardless of which sister agency they are affiliated with, to log on once through the PNM portal to access ODM and sister agency provider systems.

Centralized Credentialing

Centralized Credentialing will simplify the credentialing process for independent Medicaid providers.  A credentialing verification organization (CVO) will take over the credentialing process when the PNM system is launched. Upon go-live, providers will no longer seek credentialing through each managed care organization. Rather, they will achieve credentialing one time every three years through ODM’s program. Once approved, providers are eligible to participate in any or every Medicaid MCO’s network.

Fiscal Intermediary  

Ohio Medicaid’s FI will act as a clearinghouse for providers, accepting and paying all fee-for-service claims and processing prior authorizations (PA), as well as accepting and forwarding all claims and PAs from providers to their designated managed care organizations (MCOs). Gainwell Technologies was officially awarded the FI contract in December. With the naming of the new contractor, Ohio Medicaid moved a step closer to realizing its vision for Ohio’s next generation managed care program.