Medicaid Annual Eligibility Redetermination Reviews

AmeriHealth Caritas Ohio and the Ohio Department of Medicaid are preparing for the resumption of Medicaid members’ annual eligibility redetermination reviews. Annual reviews resumed on May 1, 2023.

This federally required process is in place to ensure those enrolled in Medicaid programs continue to meet established eligibility criteria. AmeriHealth Caritas Ohio will collaborate with Ohio Department of Medicaid and our provider network to minimize the burden on our members and promote continuity of health coverage.

If a member has received an eligibility redetermination notice or a request for additional information from the Ohio Department of Medicaid, it is especially important that they respond promptly to help ensure continuation of their benefit coverage. Additionally, it is critical that the Ohio Department of Medicaid has updated contact information for its Medicaid members. If members have moved without informing Ohio Department of Medicaid, they may miss essential information needed to maintain their Medicaid coverage.

Timely recertification is important because it:

  • Helps ensure continuity of care for our plan members/your patients
  • Eases administrative burden when verifying member eligibility
  • Avoids the need for resubmission of prior authorization requests for certain services that may be required due to gaps in care caused by lapsed Medicaid coverage
  • Supports timely deeming of newborns as Medicaid-eligible and ensures Mom and baby are both on the AmeriHealth Caritas Ohio plan

How can providers help?

Providers can help by relaying consistent and simple messages to Medicaid members, stressing the importance of responding promptly to any requests for information from the Ohio Department of Medicaid. Providers are also encouraged to direct members to the AmeriHealth Caritas Ohio Member Redetermination webpage for more information.

Additionally, the following new tools have been launched in the NaviNet Provider Portal that will allow providers to view upcoming Medicaid Member Annual Eligibility Redetermination dates. 

New redetermination tools in the NaviNet portal

  • Medicaid Member Annual Eligibility Redetermination Pop-Up Alert
    In the Eligibility and Benefits screen under the Patient Alert Details pop-up, there will be a new Redetermination Report link that, when clicked, will display the member’s upcoming eligibility redetermination date. The new pop-up alert will be very similar to the existing Care Gap and PCP History alerts and will be available to all provider types.
  • Medicaid Member Annual Eligibility Redetermination Report
    In the Administrative Report Inquiry section, a new report will be available for PCPs under the report drop-down list that provides a full list of all members on your roster who have upcoming eligibility redetermination dates. The report will be available for PCPs to download in both PDF and Excel formats.

You can use these new tools to verify the Medicaid Annual Eligibility Redetermination status of your patients who are AmeriHealth Caritas Ohio members. If you receive an alert or report in NaviNet that indicates your plan member has an upcoming eligibility redetermination date, you can help ensure their continued coverage by stressing the urgency of timely recertification and directing those in need of assistance to Member Services at 1-833-764-7700 (TTY 1-833-889-6446).

If you have any questions, please feel free to contact your AmeriHealth Caritas Ohio Provider Account Executive or Provider Services at 1-833-644-6001. AmeriHealth Caritas Ohio members who require assistance should be directed to Member Services at 1-833-764-7700 (TTY 1-833-889-6446).