OhioRISE (Resilience through Integrated Systems and Excellence)

As a part Ohio Medicaid’s effort to launch the next generation of Medicaid, ODM will implement OhioRISE (Resilience through Integrated Systems and Excellence), a specialized managed care program for youth with complex behavioral health and multi-system needs.



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IMPORTANT UPDATE: Ohio Medicaid is upgrading its provider enrollment system

Effective August 1, 2022, ODM will not be accepting new provider enrollment applications or continue any in-progress enrollment applications through the MITS Provider Enrollment System. Details on the process for enrollment of new OhioRISE providers from August 1 to October 2022 will be communicated prior to August 1st. Effective October 1, 2022, all provider enrollment applications must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) portal. After its implementation, the PNM portal will be the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service. Provider Network Management Portal and Centralized Credentialing Beginning on October 1, 2022 the Provider Network Management (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 importan...
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CO Supreme Court: Hospital Cannot Enforce $229K Surprise Bill

The surprise bill stemmed from the hospital’s chargemaster rate, but the hospital did not provide this information to the patient before her surgery. The Colorado Supreme Court has ruled that a woman is not liable for her $229,000 surprise bill from a Centura Health hospital, as the hospital did not disclose the amount to her before the procedure. Lisa Melody French received spinal surgery at St. Anthony North Hospital in Westminster, Colorado, in 2014. The hospital initially estimated that the surgery would cost $57,601, with French responsible for paying $1,337 out-of-pocket. But the cost increased to $229,112 following the surgery. According to the court document, the new price tag reflected Centura’s full chargemaster rates for the surgery. Additionally, Centura determined that it had misread French’s insurance card and she was an out-of-network patient. French was left with the nearly $230,000 bill after her insurance paid $73,597 of the new charge, which was over $300,000. Fren...
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Governor DeWine Announces Local Government Payments from National Opioid Settlement Begin

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    Ohio Governor Mike DeWine announced Friday that the first payments of funds to local governments from the OneOhio settlement with national opioid distributors have been made electronically. Local governments will determine how to use the payments, totaling more than $8.6 million, to best combat the opioid epidemic in their own communities. Following these initial payments, governments will continue receiving payments from the settlement over the next 18 years. In 2017, as Ohio Attorney General, Governor DeWine was one of the first in the nation to sue opioid makers and drug distributors for their role in flooding the market with massive amounts of highly addictive opioids. A complete list of payments made to eligible and participating political subdivisions may be found at https://nationalopioidsettlement.com/states/ohio/ . The list also indicates if the payment was made directly to the entity or, if less than $500, was redirected to the county. Questions about payments c...
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