MedicaidAdministrativeHigh impact
Ohio Medicaid: Provider enrollment requirement
UnitedHealthcare·OH·State news
We identified it
Jul 2, 2026
Summary
Ohio Medicaid now requires all providers serving Medicaid managed care and OhioRISE members to be enrolled and active in the Provider Network Management (PNM) system before rendering and billing services. Claims from unenrolled providers will be rejected at the EDI front door, not paid, and not accepted as encounters. Providers must verify enrollment status immediately and complete enrollment through one of four available options to avoid claim denials.
Action Required
IMMEDIATELY: Billing team must verify enrollment status of all providers in Ohio's Provider Network Management (PNM) system at the ODM portal. For any unenrolled providers: (1) Complete online PNM enrollment using the MCP Single Case option (preferred), OR (2) Complete paper forms ODM 10282 and ODM 10283 and submit to the MCE, OR (3) For temporary access only, complete ODM form 10295 for 120-day enrollment, OR (4) For pharmacies, submit ODM form 10298. Do NOT submit claims for Medicaid managed care, OhioRISE, or SPBM services until providers are enrolled and active in PNM. Update billing system to flag any Ohio Medicaid claims from providers not confirmed as active in PNM and route for enrollment verification before submission. Consequences: Claims from unenrolled providers will be rejected at EDI, held pending enrollment, or denied with CARC 226/RARC N767. Payments already made due to enrollment gaps cannot be recouped.