Wiki Credentialing with Medicaid for New Private Practice

[peasekiara@gmail.com]

I am working with a new private practice that will be opening in May. They would like to get credentialed with Medicaid. We are located in Ohio.

Everything I am reading says that the practice needs to be certified through the Ohio Department of Behavioral Health. However, when I go to apply through the LACTS portal, it says there is a requirement of an accreditation to be a provider. There are other private practices that have opened after the house bill that went into effect after September of 2023 requiring the accreditation and are billing Medicaid without being accredited/certified.

Could someone point me in the direction of how to get the practice credentialed with the Ohio Medicaid Managed Care companies without being accredited/certified as a OBH provider? Or if this is all not a possibility. I just want to make sure I am exhausting all options.

Thank you!!

 

[sls314]

I am working with a new private practice that will be opening in May. They would like to get credentialed with Medicaid. We are located in Ohio.

Everything I am reading says that the practice needs to be certified through the Ohio Department of Behavioral Health. However, when I go to apply through the LACTS portal, it says there is a requirement of an accreditation to be a provider. There are other private practices that have opened after the house bill that went into effect after September of 2023 requiring the accreditation and are billing Medicaid without being accredited/certified.

Could someone point me in the direction of how to get the practice credentialed with the Ohio Medicaid Managed Care companies without being accredited/certified as a OBH provider? Or if this is all not a possibility. I just want to make sure I am exhausting all options.

Thank you!!

From a quick review of the bill, the requirement appears to apply to new applications submitted on or after October 3, 2023. For providers who were already operating or who had applications in process before that date, they had until October 3, 2025 to comply with the requirement.

There were 2 listed exceptions: Federally Qualified Health Centers (FQHCs) and Ohio-licensed healthcare professionals whose scope of practice already includes the service

If you know a practice that submitted an initial application after October 3, 2023 and didn't meet the requirement or one of the exceptions, perhaps you could ask them about their application process?


Disclaimer: I'm in Ohio, but don't work specifically in behavioral health. The above comes only from reviewing the HB 33 info and the Ohio Medicaid website