MyCare Ohio Resources
The Ohio Department of Medicaid has begun work on the development of the Next Generation MyCare program to expand statewide and implement some of the same program requirements and benefits as the Next Generation managed care program. We aim to provide Ohioans enrolled in MyCare Ohio a better healthcare experience, improve program transparency, and decrease administrative burden for providers.
In March, the MyCare Ohio team kicked off MyCare Ohio program community input sessions to hear provider experiences navigating the current Financial Alignment Initiative demonstration, and other Fully Integrated Dual-Eligible Special Needs plan (FIDE-SNP) models. Feedback collected during the community input sessions will inform efforts to prepare you for the changes coming to the MyCare Ohio program. Learn more about the MyCare Ohio program and community input sessions by reviewing the following resources:
- MyCare Ohio program webpage shares information and resources about the program and the different ways members can receive services, contact information for the MyCare Ohio plans, and details about the MyCare community input sessions.
- MyCare Ohio program community input session provider frequently asked questions shares questions and answers about the provider community input sessions.
- MyCare Ohio frequently asked questions highlights common questions about the program and options available to members.
- MyCare Ohio program one-pager provides information an individual may need to know about the program at a glance, including eligibility and where in Ohio the program is available.
- MyCare Ohio waiver one-pager provides information an individual may need to know about available waiver services at a glance.
Learn more about the MyCare Ohio program by visiting the MyCare Ohio webpage on the Ohio Medicaid website. If you have questions or feedback about the Next Generation MyCare program, please contact MyCare Conversion Questions.
Forms & Reference Links
HCBS Provider Training Modules & Reference Guides
- MyCare Program Overview (PDF)
- Prior Authorizations, Home Health (PDF)
- Home Health Agency and Home Care Providers (PDF)
- Independent Providers (non-agency) - Resource Coming Soon
- Home Modification and Vehicle Modification (PDF)
- Waiver Transportation Provider - Frequently Asked Questions (FAQ) (PDF)
- Medical Supplies and Equipment Providers - Resource Coming Soon
- Assisted Living Providers - Resource Coming Soon
- Waiver Provider Reference Guide (PDF)
MyCare Ohio Home & Community Based Providers Click here to join email listing for Updates, Notifications, Webinar Invites & Events.
Check Run Schedule Changes
To improve the timeliness and consistency of the claim payment process, Buckeye is adjusting the check run schedule. Beginning September 19, 2016, Buckeye’s twice weekly check run dates will occur as follows:
| Medicare | Medicaid Waiver | |
|---|---|---|
| Current | Tuesday & Thursday | Wednesday & Friday |
| Effective Sept. 19, 2016 | Monday & Thursday | Tuesday & Friday |
Keep in mind that this change would mainly effect transmissions submitted on a Sunday.
To further compliment timely payment contact PaySpan at (877) 331-7154 for electronic remittance and funds transfer capabilities.
MyCare Ohio Home & Community Based Providers Click here to join email listing for Updates, Notifications, Webinar Invites & Events.
Home Health Rate and Billing Changes
ODM announces changes to home health rates (PDF)
Buckeye MyCare Ohio Provider Job Board
The Buckeye MyCare Ohio Provider Job Board connects providers with members requiring services. By using this tool, Waiver Service Coordinators and Care Managers are able to post a secure, confidential notice that a member is in need of new or additional providers. Providers will be able to see these postings and apply as appropriate.
- Job Board
- FAQs
- Job Board User Guide
Opting Out of Buckeye MyCare Ohio Medicare Coverage
MyCare Ohio allows for individuals to opt-out of Medicare coverage from the plan managing their MyCare Ohio benefits.
Providers need to confirm the MyCare Ohio member’s option for Medicare coverage. If a member chooses to Opt Out of Buckeye MyCare Ohio for their Medicare benefits, Buckeye will only manage Medicaid benefits, and will only reimburse claims for Medicaid services. Claims for Medicare must be submitted to the plan managing their Medicare benefits.
Therefore, it is important to verify member eligibility prior to each service rendered. Providers may use our secure Provider Portal on our website to check member eligibility, or call our Provider Services Department.
- Provider Portal: Please log onto our Provider Portal, then click “Member Eligibility”
- MyCare Concierge Team: 866-296-8731
If your patient has chosen to Opt Out of the Medicare portion of MyCare OH, Buckeye Health Plan is managing the Medicaid benefits and will only reimburse claims for Medicaid services. A Prior Authorization for secondary payment from Buckeye is not required for the service(s) covered by their Medicare plan. Please submit the claim(s) to the plan managing the Medicare benefits (Medicare Fee For Service or Medicare Advantage Plan/Medicare Part C).