Anthem

Ohio Providers

Welcome Providers!

Anthem is committed to the Ohio Department of Medicaid’s goal of focusing on the individual, and improving design, delivery and timeliness of care coordination. We combine national expertise with an experienced local staff to operate community-based healthcare plans.

Anthem is dedicated to offering real solutions that improve health care access and quality for our members. We’re here to help you provide quality healthcare to our members.

On this site, you’ll find resources that help health care professionals do what they do best — care for our members.

Anthem Medicaid in Ohio

Earlier this year, Anthem acquired Paramount Advantage’s Ohio Medicaid membership. Paramount Advantage will continue to manage this membership on Anthem’s behalf under a Transition Service Agreement (TSA) until the Ohio Department of Medicaid (ODM) launches the new Fiscal Intermediary (FI) on 12/1/2022.

At that time, providers will begin submitting claims and authorization requests to Anthem using this new FI process. Please note ODM will no longer allow providers to submit paper claims for Dates of Service on or after the launch of the FI.

Once the FI has launched, Anthem will be a new statewide Medicaid plan supporting members across Ohio’s 88 counties. Our new plan is part of the ODM Next Generation program of managed care.

Existing Paramount Advantage contracted providers can continue billing Paramount Advantage for Anthem members under their current Paramount Medicaid contract until the launch of the ODM Fiscal Intermediary’s ‘Front Door’. However, providers will need to establish a contract with Anthem to continue providing services to members after the ODM FI launches.

If you are an existing Paramount Advantage Medicaid provider without an Anthem contract or are a new provider seeking an Anthem contract, please complete our Provider Maintenance Form.

Important updates on Next Generation services and rollout:

ODM has revised the rollout of the Next Generation program, which will phase in the various specialized plans and services over the next few months. Dates and details providers should be familiar with that are specific to Anthem membership and how to best support our members include:

Launching 7/1/22

OhioRISE: OhioRISE is a specialized managed care program for youth with complex behavioral health and multi-system needs administered by Aetna Better Health of Ohio. Members enrolled in this program will receive new Anthem OhioRISE cards with effective dates as early as July 1st.

Members with this card will have their physical health needs covered by Anthem (being administered by Paramount until the FI goes live on 12/1/2022) and their behavioral health needs covered by Aetna Better Health of Ohio. This card will give providers instructions to bill Aetna for OhioRISE behavioral health services and Paramount Advantage for physical health services directly until ODM’s FI launches on December 1st.

Once the FI launches, members will receive a new card with updated instructions on billing services through ODM’s FI for both behavioral and physical health covered services while providers will direct their claims to Anthem (not Paramount Advantage) via the FI. For more information on the OhioRISE program please email OhioRISE@medicaid.ohio.gov.

Launching 10/1/22

Single Pharmacy Benefit Manager (SPBM): The new SPBM launching in October will replace the current plan’s PBM for Medicaid members. ODM selected Gainwell to be the Single Pharmacy Benefit Manager for all Ohio Medicaid members. This will improve the management and administration of pharmacy benefits for managed care recipients, providing more transparency and increased financial accountability. For more information on Specialty Pharmacy Benefit Manager email Medicaid.SPMB@medicaid.ohio.gov.

Centralized Provider Credentialing and Provider Network Management: The new Provider Network Management (PNM) module will replace MITS. The PNM will be used to manage provider Medicaid ID applications and allow for centralized credentialing.

Providers working with ODM will now have one credentialing and recredentialing process at the state level, eliminating additional credentialing processes performed by each Medicaid managed care organization (MCO). If you have more questions on credentialing, email credentialing@medicaid.ohio.gov.

Please note: This credentialling process only covers Ohio Medicaid credentialling. Providers are required to continue credentialling through Anthem for other lines of business such as Commercial and Medicare.

Launching 12/1/2022

Fiscal Intermediary (FI): ODM’s single point of entry for all provider claims and prior authorization requests, regardless of which Medicaid managed care plan the member is enrolled with.

Anthem members will receive new Anthem cards prior to the FI launch instructing providers to send claims and authorization requests through the FI. For Dates of Service (DOS) on or after the FI launch, Paramount Advantage will no longer administer claims and authorizations. Instead, claims and authorization requests will be sent by ODM to Anthem for processing. For more information on the Fiscal Intermediary email ODMFiscalIntermediary@medicaid.ohio.gov.

Please note: Providers will continue to work with Paramount Advantage directly for claims submitted with prior DOS for new day, correction, retrospective authorizations, or disputes.

What’s next?

ODM is committed to launching the Next Generation of Ohio Medicaid Managed Care successfully. The phased timeline assures no disruption to the members’ care or provider support. Eligible members will continue to receive the full complement of Medicaid benefits. Providers will continue serving the millions of Ohioans covered by Medicaid, working with current MCOs using processes and procedures practiced today.

Additional details will be available soon to guide members, providers, and stakeholders through the next steps. To keep up to date with the Next Generation of Ohio Medicaid please visit managedcare.medicaid.ohio.gov or email your questions to ODMNextGen@medicaid.ohio.gov.

Find providers in our network

View our online provider directory.

Centralized credentialing with the Ohio Department of Medicaid

Beginning 10/01/2022 the Next Generation of the Ohio Department of Medicaid (ODM) will require centralized credentialing for all Medicaid managed care organizations provided by Gainwell Technologies on behalf of ODM. The managed care organizations must accept ODM’s credentialing status and must not request any credentialing or re-credentialing information from an ODM-enrolled provider. You can check your credentialing status by checking ODM’s provider network management system.

Credentialing Resources

Credentialing before October 1st

For all information regarding credentialing and recredentialing processes before 10/01/2022 please refer to Anthem’s Ohio Commercial Credentialing Program Summary.

Availity access

The Availity Portal offers health care professionals free access to real-time information and instant responses in a consistent format regardless of the payer. Register and log in for access to help and training materials. Registration is free!

Provider manual

The Anthem provider manual will provide key administrative information, including the quality improvement program, the utilization management program, quality standards, claims appeals, and reimbursement and administration policy information.

Provider news

Our provider news communications page will allow providers to stay current on Anthem Blue Cross and Blue Shield policies and processes, state and federal regulatory changes, and other issues affecting your practice and patients.

Training resources

Our new and improved Training Academy will supply all our providers with more training resources, tools, and continuing education opportunities to best serve our members. These resources will be easier to access through our newly designed Training Academy with pages dedicated to:

  • Training resources
  • Continuing Medical Education (CME) courses
  • Screening, Brief Intervention, and Referral to Treatment (SBIRT)
  • Schedules and registration
  • Serving diverse populations/Cultural competency
  • A full resource library

Contact us

Do you have questions about provider relations, checking your network status, or how to enroll in our network? Give us a call at 844-912-0938.


Phone:

844-912-0938

Join our network

We’re glad you’re interested in joining the Anthem network. We have a diverse network of exceptional healthcare professionals who ensure our members have uninterrupted access to the support they need.