A female physician writes a prescription for a male patient

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.

When filing electronic Medicaid claims, please use Payer ID 61103 for your patients with coverage through Humana Healthy Horizons in Ohio. Please do not use Humana’s traditional Payer ID for fee-for-service claims (61101) when submitting Humana Healthy Horizons in Ohio Medicaid claims. Learn more about filing electronic claims .

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:

  • Sign in to the Ohio State Digital Identity Standard
  • Select Create Account

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:

  • Calling 800-686-1516
  • Emailing  IHD@Medicaid.Ohio.gov

Access additional PNM and credentialing resources

Ohio Medicaid

  • Humana Healthy Horizons in Ohio
  • Answers to FAQs
  • Availity
  • Clinical coverage policies
  • Behavioral health toolkit
  • Claims and payments
  • Clinical practice guidelines
  • Communications and network notices
  • Documents and resources
  • External medical review
  • Join our network
  • Optimization of pregnancy outcomes
  • Pharmacy
  • Prior authorization
  • Provider network management
  • Services for children
  • Telehealth services
  • Training materials