Pharmacists Are Now Able to Enroll with Medicaid - Medic Management

The Ohio Department of Medicaid (ODM) announced good news for individual pharmacists this year.  As of January 17, 2021, ODM is enrolling pharmacists in accordance with rule 5160-8-52 of the Ohio Administrative Code. Prior to this year, ODM only enrolled pharmacies and not individual pharmacists. This change will allow pharmacists providing services such as managing medication therapy for patients to enroll as billing providers.  They will be able to submit claims under their own Medicaid identification numbers. In addition to ODM, the update also applies to Medicaid MCOs (Managed Care Organizations).

ODM’s enrollment process for pharmacists is similar to that of other providers, and the application can be completed on Medicaid’s website.  After indicating that the application is for an individual practitioner, the provider type 69-Pharmacist would be selected.  Currently, it is taking less than two weeks for ODM to process an application.

When it comes to the Medicaid MCOs, they all have their own processes for enrolling pharmacists with an existing group.  However, since ODM will be taking over all the Medicaid MCO provider credentialing in the near future, pharmacists do not have to have CAQH applications and go through the credentialing process at each of the MCOs.  The Medicaid MCOs have agreed that they will accept ODM’s credentialing at this time.

The following is a breakdown of what we have been told by each of the MCOs as of March 15, 2021 when it comes to enrolling pharmacists with an existing group:

• Buckeye Health Plan: The enrollment process for pharmacists is the same as for other providers. This is done by submitting a “New Provider Information Form” to their contracting department. We were informed that an additional amendment or contract was not needed.
• CareSource: The enrollment process is the same as for other providers. They are submitted either through their portal or on a hierarchy form emailed to their provider maintenance department.
• Molina: As with Buckeye, there is not an additional amendment or contract needed. In order to add a pharmacist to a group, they need a “Provider Information Form” submitted.
• Paramount: The only step to add a pharmacist is to send their information to Paramount the same as any other provider. We were informed that an additional amendment or contract was not needed.
• United Healthcare Community Plan: As of March 9, 2021, UHC is still having internal discussion regarding contracting pharmacists.

While pharmacists can now be enrolled with ODM and Medicaid MCOs, they are still not being enrolled by Medicare or commercial insurances.  This could change in the future to meet the needs of patients who require help managing medication.  If you have a pharmacist that would like to be enrolled with the Medicaid MCOs and is not part of an existing contracting group, please reach out to each of the insurances for information.

Jessica Roe is a Credentialing Manager with Medic Management Group, LLC.  She has been with MMG for more than sixteen years providing credentialing support to clients across a broad range of specialty areas.  Her active clients include independent practice groups, health systems, behavioral health providers, and urgent care centers.  Prior to joining MMG, Jessica spent nine years in business positions within an independent practice group.