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WELCOME TO
OHIO MEDICAID
PHARMACY SERVICES

SUPPORTED BY GAINWELL PHARMACY SERVICES.

Announcements

08/22/2022


Register today for SPBM Provider Web Portal training!


Registration for S PBM Web Portal training is now open for all pharmacists,
pharmacy support staff, prescribers, prescriber support staff, and managed care
entity portal administrators and staff. Training dates and registration links to
individual training sessions are listed below.

Please join the Gainwell Ohio SPBM training staff to learn the difference
between the public and the secure portals, including how to register for the
latter. During the training, you will also learn about many exciting tools
available on the SPBM Web Portal such as member eligibility verification, prior
authorization submission for prescribers, the ability to quickly speak with the
SPBM help desk, and much more!

Prescriber and prescriber support staff training begins on Sept. 6.  For
training registration instructions, click here.

Pharmacy and pharmacy support staff training begins on Sept. 19.  For training
registration instructions, click here.

MCE Portal Administrator and MCE  staff training begins on Sept. 20.  For
training registration instructions, click here.






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05/0 1/2022

Welcome to the new Ohio Medicaid pharmacy services online portal.

This is a soft launch of the SPBM online portal with limited fea tures.


Thank you for your patience as we continue to enhance the system.



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 * General
 * Member
 * Provider
 * MCE

Welcome to Ohio Medicaid Pharmacy Services Online Portal
This website provides information to members, pharmacies, prescribers, Managed
Care Entities, and the public. Users may find helpful website links and
documents within our online portal in the menu bar above.
Medicaid News

Modified
Pharmacy Directory
09/12/2022 12:47:18 AM

--------------------------------------------------------------------------------

Ohio Medicaid Single Pharmacy Benefit Manager (SPBM)
04/30/2022 03:45:29 PM

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1 - 2 of 2 items
Members
Log in to the member secure portal to view your:

 * Medicaid claims and notifications
 * Medicaid programs and benefits
 * Directory of providers

Providers / Trading Partners
Login to the provider secure portal to:

 * View Medicaid eligibility and history
 * Submit claims
 * Submit authorization requests
 * Check document status
 * Resume provider enrollment application
 * Check provider enrollment application status

 * How to Apply for Medicaid
 * Medicaid Card Information
 * Medicaid Member Handbook
 * Pharmacy Directory

You may apply for Medicaid benefits by:

 * Going to Ohio Benefits
   
 * You can also call or visit your local county office for help with benefits at
   1-844-640-OHIO (6446). TTY: 711

Gainwell Pharmacy Services follows state and federal civil rights laws that
protect you from discrimination or unfair treatment. We do not treat a person
differently because of a person’s age, race, color, national origin, religion,
sex, gender identity, sexual orientation, marital status, mental or physical
disability, medical history, health status, genetic information, evidence of
insurability, or geographic location. If you would like to file a complaint
about unfair treatment, or for any other reason, please contact Gainwell by
mail, phone, or email at:

Gainwell Pharmacy Services
5475 Rings Rd.
Atrium II North Tower, Suite 125
Dublin, Ohio 43017-7565
OH_MCD_PBM@GainwellTechnologies.com

If you are enrolled in Managed Care, you will receive a card from your managed
care plan.

You can access the Member Handbook here .

Your guide to Medicaid and other information about your Medicaid benefits can be
found in the Member section of the Medicaid Managed Care Plan websites.


Pharmacy Directory will be temporarily available here until the Pharmacy
Directory search function becomes available soon.

 * Portal Registration
 * Provider Enrollment and Contracting
 * Pharmacy Billing Information
 * Provider Manual
 * Prescriber SPBM Web Portal Training
 * Pharmacy SPBM Web Portal Training

Any provider (prescriber or pharmacy) that wishes to use the Portal to exchange
PHI will be required to register as a trading partner. Pharmacies and
prescribing providers must be enrolled with Ohio Medicaid prior to registering
as a trading partner. Trading partner account registration/activation enables
access to the secure provider portal for direct data entry of claims and prior
authorizations, member eligibility inquiries, claim status inquiries, remittance
advice, and more. Registration will begin Fall 2022.

Before beginning the enrollment or re-enrollment process, gather all information
needed to complete an application. A detailed description of how to complete
each of the enrollment steps and a list of information to have on hand before
starting the enrollment application is available at: Provider Enrollment.


The Provider Network Management (PNM) module is going live in parallel with the
Single Pharmacy Benefit Manager (SPBM) on Oct. 1. PNM will replace MITS provider
enrollment and provider data management. This launch also includes a new
requirement to establish an OH|ID to access any of ODM's Ohio Medicaid
Enterprise Systems (OMES).




To allow providers an advanced opportunity to set up their OH|ID and associate
their accounts, ODM has launched a PNM pre-registration site
at: https://pnm-preregistration.omes.maximus.com . The PNM Pre-Registration tool
is available until Sept. 23 and will ease the transition and prevent disruptions
to system access for providers ahead of go-live on Oct. 1. Additionally, PNM
training is now available for providers in a variety of formats, including
virtual, in-person, and self-paced. Please access this job aid for step-by-step
instructions to sign up for a session.


For further information regarding network contracting with Gainwell, please
contact us at OH_MCD_PBM_Network@gainwelltechnologies.com .


Payer sheet is available here.

The Provider Manual, also known as the Pharmacy Reference Guide, is
available here.


Register today for SPBM Web Portal training!

Registration for SPBM Web Portal training is now open for all prescribers and
support staff.

Please join the Gainwell Ohio SPBM training staff to learn the difference
between the public and the secure portals, including how to register for the
latter. During the training, you will also learn about many exciting tools
available on the SPBM Web Portal such as member eligibility verification, prior
authorization submission for prescribers, the ability to quickly speak with the
SPBM help desk, and much more! 

Prescriber training begins on Sept. 6. For training registration
instructions, cl ic k here.




Register today for SPBM Web Portal training!

Registration for SPBM Web Portal training is now open for all pharmacies and
support staff.

Please join the Gainwell Ohio SPBM training staff to learn the difference
between the public and the secure portals, including how to register for the
latter. During the training, you will also learn about many exciting tools
available on the SPBM Web Portal such as member eligibility verification,
viewing prior authorization status, the ability to quickly speak with the SPBM
help desk, and much more!

Pharmacy and pharmacy support staff training begins on Sept. 19. For training
registration instructions, click here.



 * MCE
 * MCE SPBM Web Portal Training

Managed Care Entities (MCE) including Managed Care Organizations (MCO) and the
Prepaid Inpatient Health Plan (PIHP), which is also known as OhioRISE, will be
given access to the SPBM online portal to view clinical profile information
about members that are actively enrolled in their associated MCE.

Clinical information that is available includes member benefit and eligibility,
pharmacy prescription claims activity, Rx prior authorizations, and Coordinated
Services Program (CSP) status will be distributed to the MCEs, however, the
portal will allow quicker access to the most current information. 



Register today for SPBM Web Portal training!

Registration for SPBM Web Portal training is now open for all Managed Care
Entity Portal Administrators and staff.

Please join the Gainwell Ohio SPBM training staff to learn the difference
between the public and the secure portals, including how to register for the
latter. During the training, you will also learn about many exciting tools
available on the SPBM Web Portal such as member eligibility verification,
viewing prior authorization status, the ability to quickly speak with the SPBM
help desk, and much more!

MCE training begins on  Sept. 20. For training registration instructions, click
here.



© 2022. Gainwell Technologies. All Rights Reserved.

Site Links

 * Privacy Policy
 * Copyrights

Resources & Tools

 * CMS Release
 * Pharmacy Center | CMS
 * Drug Recalls | FDA
 * Drug Shortages List
 * Provider Network Management
 * Unified Preferred Drug List
 * ODM DUR Board
 * ODM P&T Committee
 * Myers and Stauffer (PPAC) - Ohio Medicaid Pharmacy

External Links

 * Ohio Department of Medicaid
 * Medicaid.gov
 * Ohio Civil Rights Commission
 * Chapter 5160-26 - Ohio Administrative Code | Ohio Laws

Medicaid Managed Care Plans

 * AmeriHealth Caritas Ohio
 * Anthem Blue Cross Blue Shield
 * Buckeye Health Plan
 * CareSource
 * Humana Healthy Horizons Ohio
 * Molina HealthCare of Ohio Inc.
 * UnitedHealthcare Community Plan

OhioRISE

 * Aetna


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