Ohio Medicaid Managed Care Provider Agreement

Ohio Medicaid Managed Care Provider Agreement – What You Need to Know

If you are a healthcare provider in Ohio, you may be interested in the Ohio Medicaid Managed Care Provider Agreement. This agreement outlines the terms and conditions under which healthcare providers can offer services to Ohio Medicaid beneficiaries who are enrolled in a managed care plan.

Managed care is a system of healthcare delivery that aims to improve the quality of care while reducing costs. Under managed care, Medicaid beneficiaries receive their healthcare services through a managed care organization (MCO) rather than through fee-for-service Medicaid. MCOs contract with providers to offer a range of services to their members.

To participate in the Ohio Medicaid Managed Care program, providers must sign a Provider Agreement with each MCO they wish to work with. The Agreement describes the rights and obligations of both the provider and MCO and sets forth the terms and conditions of payment.

Some of the key provisions of the Ohio Medicaid Managed Care Provider Agreement include:

1. Patient care and management

Providers are required to provide high-quality care that is consistent with the standards of practice in the medical profession. They must also agree to follow the MCO`s policies and procedures related to patient care and management.

2. Network participation

Providers must agree to participate in the MCO`s network and provide services to MCO members. They must also agree to follow the MCO`s policies and procedures related to network participation.

3. Payment

Providers are paid for the services they provide to MCO members according to the payment rates set forth in the Provider Agreement. Payment is subject to adjustment based on various factors, including the provider`s compliance with the Agreement and the MCO`s quality assurance program.

4. Compliance

Providers must comply with all applicable state and federal laws and regulations. They must also comply with the MCO`s policies and procedures related to compliance.

5. Termination

Either party may terminate the Provider Agreement upon written notice to the other party. The Agreement also provides for termination in certain circumstances, such as the provider`s breach of the Agreement or loss of licensure.

In summary, the Ohio Medicaid Managed Care Provider Agreement is a critical document that outlines the terms and conditions of participation in the Ohio Medicaid Managed Care program. Providers who wish to offer services to Medicaid beneficiaries enrolled in a managed care plan must sign a Provider Agreement with each MCO they wish to work with. By doing so, they can help ensure that they are providing high-quality care while receiving fair and timely payment for their services.

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