Starting October 1, new credentialing requirements for Medicaid providers will become effective as outlined in ODM’s new credentialing rule (5160-1-42). This rule implements national credentialing standards for independently licensed providers and certain facilities and will be required as part of centralized credentialing and the transition to the PNM. This rule provides the process and requirements ODM, or its credentialing designee, will follow for applicable providers that require credentialing for their specific provider type. This rule also identifies the required information needed to complete the credentialing process and details any additional actions necessary on behalf of the provider or facility to complete credentialing. See paragraph (B) of the rule for the list of practitioners required to complete credentialing and paragraph © for the information required. See paragraph (C) of the rule for the list of facilities required to complete credentialing and paragraph (F) for the information required.

ODM plans to align initial credentialing for independently licensed providers already enrolled with Medicaid with the provider’s Medicaid revalidation date and is currently planning to resume provider revalidation beginning October 1. Providers will receive a letter from ODM 90 days in advance of their revalidation date, and organizations can check the ODM Provider Revalidation website, which will include a list of upcoming provider revalidations once the process resumes. Independently licensed providers will complete one application in the PNM that will cover both the credentialing and enrollment/revalidation requirements. Providers can prepare for the credentialing process now by ensuring independently licensed practitioners have established profiles with the Council for Affordable Quality Health (CAQH), as this is a requirement of the ODM credentialing rule.

Independently licensed providers enrolling as new Medicaid providers after October 1, 2022, will need to comply with the new ODM credentialing rule as part of their new enrollment application.

Additionally, the requirement to enroll all Medicaid providers (dependently licensed, certified, paraprofessionals, certified peers, etc.) will continue with the implementation of the PNM and provider enrollments and updates will resume in the new system starting October 1.