Ohio Medicaid: Prepare for the Next Generation launch

Last modified: April 11, 2023

Updated to include Payer ID numbers and additional details

When the next phase of the Ohio Department of Medicaid (ODM) Next Generation Program launches on Feb. 1, the greatest impact to health care professionals will be to the new Electronic Data Interchange (EDI) and Fiscal Intermediary (FI). As ODM phases in these new system components, some of your day‐to‐day processes will change.

Claims and prior authorizations submitted through a trading partner

What’s changing on Feb. 1:

• ODM’s new EDI will begin accepting trading partner fee‐for‐service (FFS) and managed care claims 
• Claims submitted to trading partners must use the Medicaid Management Information System (MMIS) Payer ID 88337
  • Obtain an MMIS Payer ID with each encounter
  • Verify member eligibility using the ID through the Provider Network Management (PNM) module, which redirects to Medicaid Information Technology System (MITS)
• Professional claims can only include 1 rendering health care professional per claim. Please submit individual claims for services rendered by multiple health care professionals (There are exceptions for Federally Qualified Health Centers and rural health clinics).

What’s not changing:

• You'll continue to submit managed care prior authorizations to us using the existing processes and Payer ID 87726 for UnitedHealthcare commercial plans, UnitedHealthcare Dual Special Needs Plans (D-SNP) and UnitedHealthcare Connected® for MyCare Ohio
• The new EDI will not accept prior authorizations of any kind

Claims and prior authorizations submitted through a portal

What’s changing on Feb. 1:

• All Next Generation plans will have portals for direct data entry
• The MMIS ID will be the identifying number used for FFS claims processing

What’s not changing:

• You'll continue to use the UnitedHealthcare Provider Portal for data center claims and prior authorizations
  • To access the provider portal, click Sign In at the top-right corner
• You'll continue to access plan eligibility through the provider portal

Questions?

If you have questions, please call us at 800-600-9007.

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