ODM Reminder to Review Provider Records

As we have previously shared, the Ohio Department of Medicaid (ODM) must validate organization information in the PNM against the Social Security Administration Death Master File. Provider organizations have previously been and will be terminated from Medicaid if deceased board members or inaccurate SSNs are listed under their organizational profile in the PNM. Medicaid will conduct this validation on an ongoing basis and will be doing so this weekend. As such, ODM sent a reminder to providers with instructions on how to verify information is accurate.

Additionally, ODM continues to validate individual provider licensure information against e-license monthly and will do so this weekend as well.  Behavioral health providers should ensure they have a process to update information related to ownership, control interest, and managing employees in the PNM for their organization and licenses for individual providers as these validations will be conducted monthly.

Below is the notice from ODM.  

Monthly Reminder!

Review and update provider records by April 26 to maintain enrollment as an Ohio Medicaid provider.

The Ohio Department of Medicaid is required by federal and state statutes to administer and monitor the integrity of its program. Central to that effort is working with Medicaid providers to ensure all reporting and administrative requirements are met. It is through these required checkpoints that the state can ensure Ohioans covered by Medicaid are receiving care from qualified, credentialed providers.

Each month Ohio Medicaid conducts two comprehensive reviews of provider and provider organization records maintained in the Provider Network Management portal to verify.

• Organizational ownership and employee management records, including listed social security numbers. For guidance see: Owner_Managing Employee Update Instructions.docx.
• Status of professional licenses and accreditations. For guidance see: Updating or Adding Professional License Information - Medicaid Provider Network Management Module.pdf

Failure to maintain these records in keeping with Ohio Medicaid's monthly verification schedule can result in immediate enrollment termination.

This email serves as your monthly reminder to review and update these records in the Medicaid Provider Network Portal each month to maintain your enrollment as an Ohio Medicaid provider.

For more information:

Technical support is available if you have questions regarding what’s required, or to check the status of your records.

Contact Ohio Medicaid’s Integrated Helpdesk at 800-686-1516 and follow the prompts for provider enrollment (option two, option two) or email [email protected]. Representatives are available Monday-Friday, 8 a.m.-4:30 p.m. Eastern time.