Common use of Ohio Medicaid Managed Care Program Clause in Contracts

Ohio Medicaid Managed Care Program. a. ODM envisions a Medicaid managed care program where ODM, the MCOs, the OhioRISE Plan, and the single pharmacy benefit manager (SPBM) coordinate and collaborate to achieve health care excellence through a seamless service delivery system for members, providers, and system partners. b. The Ohio Medicaid managed care program consists of the following three types of managed care entities that, under XXX's leadership, must collaborate closely to meet program goals: MCOs are responsible for providing, managing, and coordinating: All covered services for adult members; Physical health services for child members; and Behavioral health services for child members not enrolled in the OhioRISE Plan. The OhioRISE Plan is a single, statewide prepaid inpatient health plan responsible for providing, managing, and coordinating behavioral health care for children eligible for the OhioRISE program. The OhioRISE program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems; and A statewide SPBM is responsible for providing and managing pharmacy benefits for all individuals. c. To reduce provider burden and promote consistency across the Ohio Medicaid managed care program, ODM has retained the administrative responsibilities for centralized claims submissions, provider enrollment, and for credentialing and re-credentialing. Upon implementation, ODM's Ohio Medicaid Enterprise System (OMES) will serve as a single clearinghouse for all medical (non-pharmacy) claims. All medical claims will be submitted to ODM's OMES, ODM’s electronic data interchange (EDI) vendor will apply specified Strategic National Implementation Process (SNIP) level edits, and ODM’s OMES will send the claim to the responsible MCO for claims processing and payment. Upon implementation, ODM's OMES will also serve as the single, centralized location for provider submissions of prior authorization requests for all medical (non-pharmacy) services. The OMES will streamline the prior authorization process and reduce provider burden by systemically standardizing prior authorization forms and the necessary clinical documentation to support the request. ODM has adopted a centralized credentialing approach, creating efficiencies through a system-level consolidation of provider screening, enrollment, and credentialing activities. Providers will submit an application for Medicaid enrollment and credentialing materials using a single, electronic application. This streamlined process will eliminate the need for providers to submit credentialing and re-credentialing materials to multiple MCOs. ODM’s provider network management (PNM) system is the State’s system of record for Medicaid provider data.

Ohio Medicaid Managed Care Program. a. ODM envisions a Medicaid managed care program where ODM, the MCOsOhioRISE Plan, the OhioRISE PlanMCOs, and the single pharmacy benefit manager (SPBM) coordinate and collaborate to achieve health care excellence through a seamless service delivery system for members, providers, and system partners. b. The Ohio Medicaid managed care program consists of the following three types of managed care entities that, under XXX's leadership, must collaborate closely to meet program goals: MCOs are responsible for providing, managing, and coordinating: All covered services for adult members; Physical health services for child members; and Behavioral health services for child members not enrolled in the OhioRISE Plan. : i. The OhioRISE Plan is a single, statewide prepaid inpatient health plan responsible for providing, managing, and coordinating behavioral health care for children eligible for the OhioRISE programProgram. The OhioRISE program Program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems; and ii. MCOs are responsible for providing, managing, and coordinating: 1. All covered services for adult members; 2. Physical health services for child members; and 3. Behavioral health services for child members not enrolled in the OhioRISE Plan. iii. A statewide SPBM is responsible for providing and managing pharmacy benefits for all individuals. c. To reduce provider burden and promote consistency across the Ohio Medicaid managed care program, ODM has retained the administrative responsibilities for centralized claims submissions, provider enrollment, submissions and for credentialing and re-credentialing. Upon implementation, . i. ODM's Ohio Medicaid Enterprise System (OMES) fiscal intermediary will serve as a single clearinghouse for all medical (non-pharmacy) claims. All medical claims will be submitted to ODM's OMESfiscal intermediary, ODM’s electronic data interchange (EDI) vendor will apply specified Strategic National Implementation Process (SNIP) level edits, and ODM’s OMES fiscal intermediary will send the claim to the responsible MCO OhioRISE Plan for claims processing and payment. ii. Upon implementation, ODM's OMES fiscal intermediary will also serve as the single, centralized location for provider submissions of prior authorization requests for all medical (non-pharmacy) services. The OMES fiscal intermediary will streamline the prior authorization process and reduce provider burden by systemically standardizing prior authorization forms and the necessary clinical documentation to support the request. iii. ODM has adopted a centralized credentialing approach, creating efficiencies through a system-level consolidation of provider screening, enrollment, and credentialing activities. Providers will submit an application for Medicaid enrollment and credentialing materials using a single, electronic application. This streamlined process will eliminate the need for providers to submit credentialing and re-credentialing materials to the OhioRISE Plan and multiple MCOs. ODM’s provider network management (PNM) system is the State’s system of record for Medicaid provider data.

Ohio Medicaid Managed Care Program. a. ODM envisions a Medicaid managed care program where ODM, the MCOs, the OhioRISE Plan, and the single pharmacy benefit manager (SPBM) coordinate and collaborate to achieve health care excellence through a seamless service delivery system for members, providers, and system partners. b. The Ohio Medicaid managed care program consists of the following three types of managed care entities that, under XXX's leadership, must collaborate closely to meet program goals: MCOs are responsible for providing, managing, and coordinating: All covered services for adult members; Physical health services for child members; and Behavioral health services for child members not enrolled in the OhioRISE Plan. The OhioRISE Plan is a single, statewide prepaid inpatient health plan responsible for providing, managing, and coordinating behavioral health care for children eligible for the OhioRISE program. The OhioRISE program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems; and A statewide SPBM is responsible for providing and managing pharmacy benefits for all individuals. c. To reduce provider burden and promote consistency across the Ohio Medicaid managed care program, ODM has retained the administrative responsibilities for centralized claims submissions, provider enrollment, submissions and for credentialing and re-credentialing. Upon implementation, ODM's Ohio Medicaid Enterprise System (OMES) will serve as a single clearinghouse for all medical (non-pharmacy) claims. All medical claims will be submitted to ODM's OMES, ODM’s electronic data interchange (EDI) vendor will apply specified Strategic National Implementation Process (SNIP) level edits, and ODM’s OMES will send the claim to the responsible MCO for claims processing and payment. Upon implementation, ODM's OMES will also serve as the single, centralized location for provider submissions of prior authorization requests for all medical (non-pharmacy) services. The OMES will streamline the prior authorization process and reduce provider burden by systemically standardizing prior authorization forms and the necessary clinical documentation to support the request. ODM has adopted a centralized credentialing approach, creating efficiencies through a system-level consolidation of provider screening, enrollment, and credentialing activities. Providers will submit an application for Medicaid enrollment and credentialing materials using a single, electronic application. This streamlined process will eliminate the need for providers to submit credentialing and re-credentialing materials to multiple MCOs. ODM’s provider network management (PNM) system is the State’s system of record for Medicaid provider data.

Ohio Medicaid Managed Care Program. a. ODM envisions a Medicaid managed care program where ODM, the MCOs, the OhioRISE Plan, and the single pharmacy benefit manager (SPBM) coordinate and collaborate to achieve health care excellence through a seamless service delivery system for members, providers, and system partners. b. The Ohio Medicaid managed care program consists of the following three types of managed care entities that, under XXXODM's leadership, must collaborate closely to meet program goals: MCOs are responsible for providing, managing, and coordinating: All covered services for adult members; Physical health services for child members; and Behavioral health services for child members not enrolled in the OhioRISE Plan. The OhioRISE Plan is a single, statewide prepaid inpatient health plan responsible for providing, managing, and coordinating behavioral health care for children eligible for the OhioRISE program. The OhioRISE program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems; and A statewide SPBM is responsible for providing and managing pharmacy benefits for all individuals. c. To reduce provider burden and promote consistency across the Ohio Medicaid managed care program, ODM has retained the administrative responsibilities for centralized claims submissions, provider enrollment, submissions and for credentialing and re-credentialing. Upon implementation, ODM's Ohio Medicaid Enterprise System (OMES) will serve as a single clearinghouse for all medical (non-pharmacy) claims. All medical claims will be submitted to ODM's OMES, ODM’s electronic data interchange (EDI) vendor will apply specified Strategic National Implementation Process (SNIP) level edits, and ODM’s OMES will send the claim to the responsible MCO for claims processing and payment. Upon implementation, ODM's OMES will also serve as the single, centralized location for provider submissions of prior authorization requests for all medical (non-pharmacy) services. The OMES will streamline the prior authorization process and reduce provider burden by systemically standardizing prior authorization forms and the necessary clinical documentation to support the request. ODM has adopted a centralized credentialing approach, creating efficiencies through a system-level consolidation of provider screening, enrollment, and credentialing activities. Providers will submit an application for Medicaid enrollment and credentialing materials using a single, electronic application. This streamlined process will eliminate the need for providers to submit credentialing and re-credentialing materials to multiple MCOs. ODM’s provider network management (PNM) system is the State’s system of record for Medicaid provider data.

Ohio Medicaid Managed Care Program. a. ODM envisions a Medicaid managed care program where ODM, the MCOs, the OhioRISE Plan, and the single pharmacy benefit manager (SPBM) coordinate and collaborate to achieve health care excellence through a seamless service delivery system for members, providers, and system partners. b. The Ohio Medicaid managed care program consists of the following three types of managed care entities that, under XXX's leadership, must collaborate closely to meet program goals: MCOs are responsible for providing, managing, and coordinating: All covered services for adult members; Physical health services for child members; and Behavioral health services for child members not enrolled in the OhioRISE Plan. The OhioRISE Plan is a single, statewide prepaid inpatient health plan responsible for providing, managing, and coordinating behavioral health care for children eligible for the OhioRISE program. The OhioRISE program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-child- serving systems; and A statewide SPBM is responsible for providing and managing pharmacy benefits for all individuals. c. To reduce provider burden and promote consistency across the Ohio Medicaid managed care program, ODM has retained the administrative responsibilities for centralized claims submissions, provider enrollment, and for credentialing and re-credentialing. . i. Upon implementation, ODM's Ohio Medicaid Enterprise System (OMES) will serve as a single clearinghouse for all medical (non-pharmacy) claims. All medical claims will be submitted to ODM's OMES, ODM’s electronic data interchange (EDI) vendor will apply specified Strategic National Implementation Process (SNIP) level edits, and ODM’s OMES will send the claim to the responsible MCO for claims processing and payment. ii. Upon implementation, ODM's OMES will also serve as the single, centralized location for provider submissions of prior authorization requests for all medical (non-pharmacy) services. The OMES will streamline the prior authorization process and reduce provider burden by systemically standardizing prior authorization forms and the necessary clinical documentation to support the request. iii. ODM has adopted a centralized credentialing approach, creating efficiencies through a system-level consolidation of provider screening, enrollment, and credentialing activities. Providers will submit an application for Medicaid enrollment and credentialing materials using a single, electronic application. This streamlined process will eliminate the need for providers to submit credentialing and re-credentialing materials to multiple MCOs. ODM’s provider network management (PNM) system is the State’s system of record for Medicaid provider data.

Ohio Medicaid Managed Care Program. a. ODM envisions a Medicaid managed care program where ODM, the MCOs, the OhioRISE Plan, and the single pharmacy benefit manager (SPBM) coordinate and collaborate to achieve health care excellence through a seamless service delivery system for members, providers, and system partners. b. The Ohio Medicaid managed care program consists of the following three types of managed care entities that, under XXX's leadership, must collaborate closely to meet program goals: MCOs are responsible for providing, managing, and coordinating: All covered services for adult members; Physical health services for child members; and Behavioral health services for child members not enrolled in the OhioRISE Plan. The OhioRISE Plan is a single, statewide prepaid inpatient health plan responsible for providing, managing, and coordinating behavioral health care for children eligible for the OhioRISE program. The OhioRISE program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems; and A statewide SPBM is responsible for providing and managing pharmacy benefits for all individuals. c. To reduce provider burden and promote consistency across the Ohio Medicaid managed care program, ODM has retained the administrative responsibilities for centralized claims submissions, provider enrollment, and for credentialing and re-credentialing. . i. Upon implementation, ODM's Ohio Medicaid Enterprise System (OMES) will serve as a single clearinghouse for all medical (non-pharmacy) claims. All medical claims will be submitted to ODM's OMES, ODM’s electronic data interchange (EDI) vendor will apply specified Strategic National Implementation Process (SNIP) level edits, and ODM’s OMES will send the claim to the responsible MCO for claims processing and payment. ii. Upon implementation, ODM's OMES will also serve as the single, centralized location for provider submissions of prior authorization requests for all medical (non-pharmacy) services. The OMES will streamline the prior authorization process and reduce provider burden by systemically standardizing prior authorization forms and the necessary clinical documentation to support the request. iii. ODM has adopted a centralized credentialing approach, creating efficiencies through a system-level consolidation of provider screening, enrollment, and credentialing activities. Providers will submit an application for Medicaid enrollment and credentialing materials using a single, electronic application. This streamlined process will eliminate the need for providers to submit credentialing and re-credentialing materials to multiple MCOs. ODM’s provider network management (PNM) system is the State’s system of record for Medicaid provider data.

Ohio Medicaid Managed Care Program. a. ODM envisions a Medicaid managed care program where ODM, the MCOs, the OhioRISE Plan, and the single pharmacy benefit manager (SPBM) coordinate and collaborate to achieve health care excellence through a seamless service delivery system for members, providers, and system partners. b. The Ohio Medicaid managed care program consists of the following three types of managed care entities that, under XXX's leadership, must collaborate closely to meet program goals: : i. MCOs are responsible for providing, managing, and coordinating: : 1. All covered services for adult members; ; 2. Physical health services for child members; and and 3. Behavioral health services for child members not enrolled in the OhioRISE Plan. ii. The OhioRISE Plan is a single, statewide prepaid inpatient health plan responsible for providing, managing, and coordinating behavioral health care for children eligible for the OhioRISE program. The OhioRISE program is designed to provide comprehensive and highly coordinated behavioral health services for children with serious/complex behavioral health needs involved in, or at risk for involvement in, multiple child-serving systems; and and iii. A statewide SPBM is responsible for providing and managing pharmacy benefits for all individuals. c. To reduce provider burden and promote consistency across the Ohio Medicaid managed care program, ODM has retained the administrative responsibilities for centralized claims submissions, provider enrollment, submissions and for credentialing and re-credentialing. Upon implementation, . i. ODM's Ohio Medicaid Enterprise System (OMES) fiscal intermediary will serve as a single clearinghouse for all medical (non-pharmacy) claims. All medical claims will be submitted to ODM's OMESfiscal intermediary, ODM’s electronic data interchange (EDI) vendor will apply specified Strategic National Implementation Process (SNIP) level edits, and ODM’s OMES fiscal intermediary will send the claim to the responsible MCO for claims processing and payment. ii. Upon implementation, ODM's OMES fiscal intermediary will also serve as the single, centralized location for provider submissions of prior authorization requests for all medical (non-pharmacy) services. The OMES fiscal intermediary will streamline the prior authorization process and reduce provider burden by systemically standardizing prior authorization forms and the necessary clinical documentation to support the request. iii. ODM has adopted a centralized credentialing approach, creating efficiencies through a system-level consolidation of provider screening, enrollment, and credentialing activities. Providers will submit an application for Medicaid enrollment and credentialing materials using a single, electronic application. This streamlined process will eliminate the need for providers to submit credentialing and re-credentialing materials to multiple MCOs. ODM’s provider network management (PNM) system is the State’s system of record for Medicaid provider data.