Ohio Type 84 & 95 Providers: Community Behavioral Health Centers

Enrollment, Affiliation & Credentialing:

CBHCs were considered MITS provider types 84 (MH) and 95 (SUD) in the state of Ohio. However, Ohio Medicaid has recently updated the older MITS interface with the newer PNM (Provider Network Management). The PNM interface is part of ODM's transition to the state's Next Generation Medicaid system.

The tools in the ODM system are focused on assisting mental health professionals with the tasks of enrollment, the affiliation of rendering practitioners and ongoing insurance credentialing requirements with Ohio managed care plans (MCPs).

For Medicaid MCP behavioral health providers, here is some general advice for enrollment and credentialing. This is a summary of the required steps. For a more complete guide, please refer to the ODM's pdf on this topic. The basic steps to complete this process are as follows:

• First: Locate the CBHC Practitioner Enrollment File. This is an online spreadsheet listing all behavioral health agencies and their affiliated practitioners.
• Second: Use the CBHC Universal Roster. This is a single roster that is submitted by behavioral health practitioners. The CBHC Universal Roster is used to report staffing changes to the Medicaid Managed Care Plans.
• Third: Use the Ohio Department of Medicaid Generated Roster. The ODM-Generated Roster is a report that uses specific information from the Provider Network Management's website.

Please note, that the state of Ohio is actively updating this system. This means that features and tools change and are no longer used. For the most up-to-date information, contact ODM or a professional revenue cycle management company that specializes in this type of insurance payor like RevUp Billing.

What If There Are Mistakes In The Enrollment File?

If mental health providers find mistakes in Medicaid's CBHC Practitioner Enrollment File, they should fix these problems. They will need to fix these mistakes and make corrections in the PNM system (formerly MITS). Practitioners should contact ODM in order to make changes to individual provider specialties as well as update any supporting documentation.

Behavioral health providers can make agency affiliation changes through Ohio Medicaid's secure portal. While doing this, all providers should review any other file information in the PNM system. Otherwise, healthcare providers should continue to monitor and ensure that their information in the Ohio Medicaid system is accurate.

This is due to the fact that this information is shared with all participating MCPs. If the data on an agency's providers is incorrect, there is a possibility of rejected or denied claims.

Outsourcing These Tasks:

Maintaining up-to-date enrollment, affiliation and credentialing information takes valuable time and resources. If CBHCs, as well as other behavioral health providers, find these requirements to be too much of a challenge, outsourcing these administrative tasks is a viable solution.

Managing this complex process and maze of payer requirements is a time-consuming task. These requirements can quickly drain resources from your practice. In this regard, it makes more sense to outsource these regulatory requirements to an agency that specializes in this activity.

About Us:

RevUp Billing prides itself on delivering experienced and professional billing and credentialing services. Their billing and credentialing specialists offer revenue cycle management (RCM) solutions that streamline a medical practice's billing, coding and claims processing tasks.

If you have additional questions about Ohio Medicaid's billing policies for community behavioral health centers or other general medical billing questions - contact us.

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Updated from original article published on February 17, 2020