On June 9, ODM sent an email to Medicaid providers informing them that they must update the CAQH database by June 15 and adjust settings to allow organizations to view data by June 15 This email was sent to all providers enrolled with Medicaid in preparation for the transition to the Provider Network Management (PNM) module later this year. ODM is planning an initial connection with the Council for Affordable Quality Healthcare (CAQH) database in June and then in August will conduct an initial data pull for independently licensed practitioners to export into MITS prior to the transition to the PNM. We do not have details on the exact plan/timeline but will share more details as they become available. We recommend providers begin the process of registering independently licensed practitioners with CAQH using the information below.

As a reminder, the Provider Network Management (PNM) will go live in October 2022, We previously shared an FAQ posted by ODM that outlines the plan for providers who are not yet credentialed. The FAQ states, “For providers that may not have been credentialed by the MCPs previously, ODM is going to use the provider’s revalidation date to initiate an opportunity for the provider to submit the necessary information for credentialing. ODM will pair up revalidation dates with recredentialing dates to minimize the administrative impact to providers during the transition and ongoing.” Currently, Medicaid provider revalidation dates are on hold through the duration of the PHE. The Ohio council will share more information related to the plan and timing for provider revalidation when it becomes available.

As previously shared, ODM introduced a new credentialing rule (5160-1-42), implementing national credentialing standards for independently licensed providers that will be required as part of Medicaid procurement and the effort towards 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 (E) 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.

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. Below are additional CAQH resources.

• CAQH ProView is an online provider data-collection solution. It streamlines provider data collection by using a standard electronic form that meets the needs of nearly every health plan, hospital and other healthcare organization. CAQH ProView enables physicians and other healthcare professionals in all 50 states and the District of Columbia to enter information free-of-charge into a secure central database and authorize healthcare organizations to access that information. CAQH ProView eliminates redundant paperwork and reduces administrative burden. CAQH ProView Login.
• CAQH FAQ
• CAQH Practice Manager Reference Guide