Medicaid FAQs for In- and Out-of-Network
Who needs to enroll in Ohio Medicaid?
In compliance with the Centers for Medicare & Medicaid Services (CMS) Medicaid Managed Care Final Rule 2390F and 42 CFR 438.602(b)(1), all managed care organization (MCO) network providers who receive payment for Medicaid members are required to be screened and enrolled with ODM. Provisions in the Affordable Care Act (ACA) require all providers to revalidate or renew their Medicare and/or Medicaid provider agreement every five years. Ohio Administrative Code 5160-1-17.4 outlines a similar provision.
How do I enroll?
To enroll, providers must complete a web-based electronic application. Ohio does not accept paper applications. The web-based provider application is designed to walk you through the steps in order to submit all the information that the Ohio Medicaid program needs to enroll you as a new provider. Please review the “Enrolling Provider Checklist” for a list of the documents you will need to submit as a part of your application. If you are unsure of what provider type to request, you should contact the Enrollment/Revalidation Hotline at 1-800-686-1516 for addition information.
Once you have completed the application, the system will provide information regarding next steps. Your next steps could include uploading or submitting additional documentation necessary for enrollment. Failure to submit the documents as required could cause your application to not be processed and you will have to begin the process all over again.
Tip: Use all CAPS (uppercase) to complete the application in order to prevent possible system errors due to internet browser variance.
What types of Provider Enrollment Applications are there?
- "New Provider" - A new service location address or a brand new provider never enrolled with OH Medicaid
- "Revalidation" - An active service location for a provider currently enrolled with OH Medicaid that requires verification of information per Federal or State regulation *Effective March 6, 2020, ODM initiated the provider revalidation waiver due to the COVID-19 Public Health Emergency (PHE). Under this waiver, no provider will be made inactive by ODM due to a failure to revalidate. While the PHE is in effect nationwide, providers who are enrolled by ODM and have a revalidation date during this period will not be required to complete the revalidation process. https://medicaid.ohio.gov/static/Providers/Enrollment+and+Support/Provider-Revalidation-Waiver.pdf
How do I track my provider enrollment application?
After you have entered your basic demographic information, the web-based system will issue you an Application Tracking Number (ATN). You should record this ATN immediately, because it will serve as your secure key to return to your application or to track it through the enrollment process.
Once an application has been submitted, you can go to the Medicaid Provider Portal to check the status. Select the “enrollment tracking search” link.
Once a provider is enrolled, they will be sent an email confirmation. This will be sent to the email that was provided during the application process.
Who should I contact with further questions?
If you have questions about Ohio Department of Medicaid (ODM) enrollment or need help, call 1-800-686-1516.
For questions concerning why Envolve has requested you take action, please contact Customer Service at 844-464-5634.