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Ohio Medicare & Medicaid Undergoing Many Policy Changes



Ohio Medicare and Medicaid are undergoing many policy and program changes—something that we know is of great interest to Ohio physicians and medical practices.


The good news is, these changes are focused on simplifying the process. The Ohio Department of Medicaid, through its next generation managed care program targeted to launch in January 2022, will feature significant components including:

  • Single Pharmacy Benefit Manager;
  • Fiscal Intermediary (single point of entry for all provider claims and prior authorization requests);
  • Provider Network Management;
  • Centralized Credentialing; and,
  • OhioRISE (Resilience through Integrated Systems and Excellence), a specialized managed care program for youth with complex behavioral and multi-system needs.


We hope OSMA members are taking advantage of the Medicare/Medicaid Update webinars to help you stay up to date and compliant with the new requirements, as well as get your claims paid in a timely way. You can still register for the on-demand webinars!

As you know, OSMA’s Government Relations and Regulatory Affairs teams work closely with Medicare/Medicaid at the state and federal level to advocate for changes that make these programs more effective and efficient for both physicians and patients.

We also work hard to gather physician feedback to help inform our advocacy efforts. If you have any questions about OSMA’s work with Medicare and Medicaid, email us at



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