Centralized Credentialing & Single Pharmacy Benefit Manager

Centralized Credentialing

Ohio Department of Medicaid (ODM) has implemented a single, centralized provider credentialing process at the state level with the go-live of the Provider Network Management (PNM) portal. Under this new process, providers will undergo only one credentialing and recredentialing process at the state level, streamlining credentialing efforts. Credentialing will be handled through the Provider Network Management (PNM) portal.

Effective October 1, Medicaid providers need a State of Ohio digital identification (OHID) to access the PNM portal and Gainwell Technologies’ single pharmacy benefit manager (SPBM) secure provider portal.

Click here to create an account through the state’s login system, ohid.ohio.gov. Providers needing technical assistance can contact Ohio Medicaid’s Integrated Help Desk (IHD) at 1-800-686-1516. The IHD is open Monday through Friday, 8 a.m.-4:30 p.m.

ODM is implementing a new Provider Network Management (PNM) module and centralized credentialing.

All Ohio Medicaid providers are required to update all of their demographic information on the Provider Master File (PMF) through Medicaid Information Technology System (MITS), prior to the anticipated freeze.

To submit a new Ohio Medicaid or Ohio MyCare credentialing request, please visit the PNM Portal.

Upon implementation of the PNM, all Ohio managed care entities (MCEs) will adhere to the PNM file format.

  • PNM & Centralized Credentialing – Find detailed information about the implementation of PNM and centralized credentialing.
  • Provider Network Management (PNM) Portal – Beginning in October 2022, the PNM portal will accept Medicaid provider enrollments and carry out centralized credentialing functions. This transition will reduce administrative burden for providers and enable providers to focus on the more meaningful and important work of providing care to members.

Please note: Providers will first need to contract with CareSource before becoming credentialed through the centralized process. Providers can complete the New Health Partner Form on the Become a Participating Provider page.

Single Pharmacy Benefit Manager (SPBM)

ODM is contracting with a new, specialized managed care organization to administer Ohio Medicaid’s prescription drug program. This new Single Pharmacy Benefit Manager (SPBM) will monitor quality, transparency and accountability for CareSource.