Ohio Medicaid MCO Payer IDs and OhioRISE Claims
By George Ruan • October 9, 2026
For Ohio Medicaid MCO payer IDs, use the official 837 Professional companion guide and confirm the member’s product before choosing an ID. The payer ID inside a professional claim is different from the EDI file’s receiver ID. Mixing them can send a correctly coded therapy claim to the wrong destination.
The reference below uses the February 6, 2026 guide, version 18.6, checked October 9, 2026. It covers standard Medicaid medical claims for the seven general MCOs plus OhioRISE. It is not a dental, vision, pharmacy or complete MyCare directory.
Sections
Medical payer IDs for the seven MCOs and OhioRISE
AmeriHealth Caritas Ohio: 35374.
Anthem Ohio Medicaid: 0002937.
Buckeye Ohio Medicaid: 0004202.
CareSource Ohio Medicaid: 0003150.
Humana Ohio Medicaid: 61103.
Molina Ohio Medicaid: 0007316.
UnitedHealthcare Ohio Medicaid: 88337.
Aetna OhioRISE: 45221.
These are the medical values listed under MCE Payer IDs in 2010BB NM109, Section 7 of ODM’s dated professional guide (pages 19–20). Preserve leading zeros. OhioRISE is the specialized behavioral health program, rather than an eighth general physical-health MCO; see the OhioRISE participation guide.
Payer ID versus receiver ID
The guide places EDI receiver routing in ISA08 and requires GS03 to match. It separately lists claim payer IDs in loop 2010BB NM109. For example, Humana’s receiver is 0021919 while its medical claim payer ID is 61103; OhioRISE uses receiver 0021914 and medical payer ID 45221. Receiver fields in Section 6 and payer fields in Section 7.
Ask your clearinghouse which field its payer-selection screen controls and how it maps that choice into the outbound file. A vendor may use its own selection label; a familiar number in a dropdown is not proof that every EDI field is correct.
Standard Medicaid is different from MyCare
Anthem’s current EDI page lists Ohio Medicaid medical payer ID 0002937 and Anthem MyCare payer ID 0022147. The company name alone is therefore insufficient to choose the claim destination. Anthem product-specific payer IDs.
CareSource’s January 20, 2026 notice similarly assigns 0021599 to MyCare claims submitted on or after January 1, 2026, irrespective of the service date. It specifically says not to send those claims to standard Ohio Medicaid ID 0003150 or Marketplace/DSNP ID 31114. CareSource MyCare routing notice.
ODM’s September 2026 MyCare update confirms statewide rollout and directs providers to PNM or 270/271 eligibility checks. Verify the product and follow current MyCare resources when it applies; do not substitute the standard-Medicaid list above.
OhioRISE and the physical-health plan can coexist
For a youth receiving therapy, confirm OhioRISE enrollment and which benefit covers the service. A physical-health MCO card does not by itself settle behavioral health routing. Use the existing Ohio eligibility walkthrough and resolve uncertainty with the applicable plan.
Aetna’s currently linked OhioRISE manual identifies payer ID 45221 and asks providers to confirm their clearinghouse is compatible with the fiscal intermediary. Confirm that connection rather than assuming any Aetna payer selection will work. OhioRISE claims guidance, page 51.
Check the outbound claim and acknowledgment
Verify coverage, product and service date before choosing the payer.
Confirm the billing and rendering records are active and the practice has the required participation.
Have the clearinghouse verify receiver routing and the medical payer field separately.
Read the acknowledgment and any rejection details before resubmitting.
For a rejected claim, ask for the actual outbound routing and rejection message, using the vendor’s secure support process. For an adjudicated denial, follow the payer’s correction or appeal instructions. The existing FFS versus managed-care claims guide covers the broader submission workflow.
How Bomi can help
Bomi can help organize payer follow-up, enrollment maintenance and billing work. Contact Bomi with the workflow you need help resolving.
Related Ohio provider guides
Counseling fee-schedule references. Ohio Medicaid authorization guidance.
Frequently Asked Questions
What is the OhioRISE medical payer ID?
The February 6, 2026 ODM professional companion guide lists 45221 in loop 2010BB NM109. It separately lists receiver ID 0021914; confirm both fields with your clearinghouse.
Is CareSource Ohio Medicaid payer ID 0003150 correct for MyCare?
No. CareSource’s 2026 MyCare notice specifies 0021599 for MyCare claims submitted January 1, 2026 onward, including earlier service dates. Match the member’s actual product.
Should I remove leading zeros from an Ohio Medicaid payer ID?
No. Preserve the published ID exactly and have the clearinghouse confirm its mapping into the outbound claim and receiver fields.
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