As a reminder, when the next generation Medicaid managed care program goes live on July 1, independently licensed behavioral health providers will be required to credential at the individual level through the Provider Network Management (PNM) module. The PNM is the platform that will be replacing MITS and will be used for provider credentialing and enrollment. The Ohio Department of Medicaid (ODM) posted an FAQ that 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.

On February 22, the Ohio Department of Medicaid refiled a new credentialing rule (5160-1-42), implementing national credentialing standards for the Medicaid program 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