In compliance with the Centers for Medicare & Medicaid Services (CMS) Medicaid Managed Care Final Rule 2390F and 42 CFR 438.602(b)(1), all managed care organization (MCO) network providers who receive payment for Medicaid members are required to be screened and enrolled with ODM. Provisions in the Affordable Care Act (ACA) require all providers to revalidate or renew their Medicare and/or Medicaid provider agreement every five years. Ohio Administrative Code 5160-1-17.4 outlines a similar provision.
Ohio Department of Medicaid Enrollment page.
To enroll, providers must complete a web-based electronic application. Ohio does not accept paper applications.
The web-based provider application is designed to walk you through the steps in order to submit all the information
that the Ohio Medicaid program needs to enroll you as a new provider. Please review the “Enrolling Provider Checklist”
for a list of the documents you will need to submit as a part of your application. If you are unsure of what provider
type to request, you should contact the Enrollment/Revalidation Hotline at 1-800-686-1516 for addition information.
Enrolling Provider Checklist by Request Type.
Once you have completed the application, the system will provide information regarding next steps. Your next steps could include
uploading or submitting additional documentation necessary for enrollment. Failure to submit the documents as required could
cause your application to not be processed and you will have to begin the process all over again.
Note: In order to prevent possible system errors due to internet browser variance please complete the application in all CAPS.
After you have entered your basic demographic information, the web-based system will issue you an Application Tracking Number (ATN).
You should record this ATN immediately, because it will serve as your secure key to return to your application or to track it
through the enrollment process.
Once an application has been submitted, you can go to the Medicaid Provider Portal to check the status. Select the “enrollment tracking search” link.
Once a provider is enrolled, they will be sent an email confirmation. This will be sent to the email that was provided during the application process.
Enrollment Tracking Search
If you have questions about Ohio Department of Medicaid (ODM) enrollment or need help, call 1-800-686-1516.
For questions concerning why Envolve has requested you take action, please contact Customer Service at 866-442-6173.