Ohio Department of Medicaid (ODM) has and continues to prepare providers for the launch of the Next Generation program through provider awareness and training efforts. Recordings of past trainings are available below, and several resources including one-pagers and FAQs are linked in the “For more information” box to the right.
1. Next Generation February 1, 2023 Launch Provider Webinar
On January 19, 2023, the Ohio Department of Medicaid conducted a webinar for providers to learn about exciting changes with the February 1, 2023 launch. This webinar included information about the changes Ohio Medicaid providers could expect, including an overview of the transition to the Next Generation managed care plans, Electronic Data Interchange, and Fiscal Intermediary.
If you were unable to attend, below you can find the presentation and recording.
- Next Generation February 1, 2023 Launch Provider Webinar Recording PowerPoint Presentation.
- Next Generation February 1, 2023 Launch Provider Webinar Recording.
2. Provider Journey Maps
What is a Provider Journey Map?
Provider journey maps are process maps that visually illustrate various activities required for providers to perform as part of their participation with the Next Generation program. The maps detail common provider activities, explaining the main actions providers perform since October 1, 2022. We encourage providers to review these maps to understand, from a high-level, how common activities will be performed and how they can prepare for these activities. Please see below for the comprehensive list of provider journey maps.
October 1, 2022 –Provider Journey Maps
- PNM module functions.
- OH|ID registration.
- Provider enrollment and credentialing.
- Integrated Helpdesk (IHD).
- Member eligibility verification.
February1, 2023 –Provider Journey Maps
- Claims submission.
- Prior authorization submission.
3. Provider Network Management Trainingand Learning Management System
In partnership with Ohio Department of Medicaid, Maximus – the Provider Network Management (PNM) module vendor – offers a variety of trainings to educate providers on the PNM module and centralized credentialing. Training sessions are available on demand so providers can conveniently access them. Maximus will add subsequent training in the future, along with targeted sessions for specific users.
To access self-paced training and resources or to sign up for future scheduled sessions, visit Absorb, the learning management system (LMS).Start Here: LMS Registration.
You must create an account in the LMS to access training sessions and PNM resources. Visit the Absord LMS job aid for instructions on creating your account and accessing PNM training.
The latest PNM training resources, including step-by-step guides, are accessible within the ‘Learning’ tab on the PNM toolbar.
4. Single Pharmacy Benefit Manager Portal Training
Helpful information, resources, and links to recordings of Gainwell Technology’s Single Pharmacy Benefit Manager (SPBM) training sessions can be found by navigating to https://spbm.medicaid.ohio.gov and selecting the “Provider” tab. Under this, you will find the menu for “SPBM Web Portal Training.”
The public-facing SPBM web portal provides instant access to reference material such as the Unified Preferred Drug List (UPDL) and criteria, the Preferred Diabetic Supply list, the Specialty Drug list, and Quantity Limits list to assist with prescribing medications to Ohio Medicaid managed care members.
The secure SPBM web portal requires credentials and provides a way to check eligibility of Ohio Medicaid managed care members, the ability for prescribers to submit prior authorizations, the ability to view claim and prior authorization history, and a secure web chat to quickly speak with the SPBM helpdesk.
If you have any questions regarding SPBM web portal training, please email OH_MCD_PBM@gainwelltechnologies.com.
5. Ohio Medicaid Single Pharmacy Benefit ManagerWebinar Recordings
March11, 2023:Single Pharmacy Benefit ManagerPharmacy Pricing and Audit ConsultantWebinar
Topics covered:
- Prepaid Ambulatory Health Plan (PAHP) overview.
- Contract overview.
Click here to view the presentation.
Click here to view the webinar recording.
April 15, 2023: Single Pharmacy Benefit Manager Specialty Pharmacy Webinar
Topics covered:
- Network criteria/credentialing.
- Specialty drug list methodology.
- Ingredient cost methodology/Ohio Average Acquisition Cost (OAAC) survey/expected pricing structure.
- Dispensing fee structure.
- Submission of claims – medical vs. Rx benefit.
- 340B considerations.
- Prior authorization process.
- Prescribing considerations/member journey.
- OAAC survey process.
Click here to view the presentation.
Click here to view the webinar recording.
June 17, 2023: Single Pharmacy Benefit ManagerPharmacy Reimbursem*nt Webinar
Topics covered:
- Overview of Next Generation Pharmacy Program reimbursem*nt structure.
- Dispensing fee overview and philosophy.
- SPBM tier scoring methodology.
- SPBM dispensing fee tiers/rates.
- Dispensing fee operational considerations.
- Ohio Average Acquisition Cost (OAAC) review.
- OAAC rates.
- OAAC operational considerations.
- SPBM contracting timelines and next steps.
Click here to view the presentation.
Click here to view the webinar recording.
Click here to view the SPBM Pharmacy Reimbursem*nt Webinar FAQ.
6. Pharmacists: Updated Provider Manual
What is the Single Pharmacy Benefit Manager Provider Manual?
As of October 1, 2022, pharmacy benefits for Medicaid managed care members covered by the Single Pharmacy Benefit Manager (SPBM), Gainwell Technologies. Gainwell’s provider manual, also known as the pharmacy reference guide, is the primary resource guide providing key information to pharmacy providers, pharmacy support staff, and prescribers. The provider manual includes information related to pharmacy claims submission, reimbursem*nt rates, pharmacy network requirements, the specialty pharmacy program, claims processing, utilization management, and prior authorization.
How Do I Access the Single Pharmacy Benefit Manager Provider Manual?
The provider manual can be found on the Resources for Pharmacists and Pharmacy Support Staff webpage.The provider manual is updated periodically to reflect program changes or clarifications as necessary.
For additional information about SPBM please visit theNext Generation SPBM webpageor the Gainwell Ohio Pharmacy portal.
