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Provider network management (PNM) and single pharmacy benefit manager (SPBM)

On Oct. 1, 2022, Gainwell Technologies, the SPBM, began providing pharmacy services across all managed care plans and for all members. Learn what this means for healthcare providers.

Doctor writing prescriptions for Medicaid patient

Next Generation Medicaid program information

The Ohio Department of Medicaid (ODM) launched its Next Generation Medicaid program on Feb. 1, 2023. ODM next will launch the full Ohio Medicaid Enterprise System (OMES) module to provide streamlined processes for claims, prior authorizations and other administrative tasks for providers.

What is an OH|ID?

The OH|ID is an account providers create through the InnovateOhio Platform. Having an OH|ID allows providers to use a single ID to access systems for multiple Ohio state agencies. Providers should set up their OH|ID and associate their existing accounts.

An OH|ID is required to access the PNM module. Each individual accessing the module must have a separate OH|ID. The OH|ID also is required to access the OMES and SPBM modules.

A provider’s OH|ID will replace any existing Medicaid Information Technology System (MITS) sign-in credentials.

Setting up your OH|ID

To create an OH|ID:

Learn more about creating an OH|ID

Get answers to frequently asked questions about the OH|ID

PNM provider file

Providers must update their ODM records in the PNM system per Ohio Administrative Code rule 5160-1-17.2(F).

Humana Healthy Horizons® in Ohio (and other managed care entities [MCEs] with whom providers work) cannot accept changes from providers that are inconsistent with PNM system data shared through the Provider Master File (PMF).

Provider data or information that is not collected in the PNM system and not included on the PMF (e.g., provider capacity, telehealth availability, specialist information) may be collected from providers by the MCEs and maintained in their systems.

Review instructions for updating a provider file:

  • After signing in to your PNM account, select Learning.

Additional information

Access the PNM module

  • After accessing the module, select Log in with OH|ID.

If you have technical issues accessing the PNM module or need other assistance, contact the ODM Integrated Help Desk by:

Access additional PNM and credentialing resources