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Provider News

Paramount wants to make your job easier. You can now stay up to date on Paramount news and updates, as well as government announcements, by visiting us here.

News from Paramount


NEW! We are updating the look of our website. Stay tuned for a new version coming soon!


NEW! Omnipod products added to Pharmacy Benefit (Non-Preferred)


NEW!  Effective 1-1-19: Ohio Department of Medicaid Treatment of Opiate Use Disorders Policy


Effective immediately: Paramount Advantage - Unified Preferred Drug List – Delayed Indefinitely


Our 2019 commercial formularies have been posted to the website.  


Process for Medicaid Pharmacy Providers to submit MAC pricing appeals to CVS/caremark. 


Opioid limits update for ProMedica Employee Health Plan (EHP).


You may now submit professional claims through MyParamount! Learn more.


Qualified Medicare Beneficiaries reminder 


Our latest edition of Network News is available.  


Prior Authorization updates for commercial members 


Opioid prescribing information for Commercial members 


EVV Notice from ODM


Opioid prescribing information for Paramount Advantage members


Claims processing changes coming 7/1/2018. Learn more! 


Updated Opioid Prior Authorization Limits for Acute Pain - Paramount Advantage, Effective July 1, 2018.


Online claims submissions and ODM behavioral health forum


Changes to Rendering Provider NPI field in the detail lines of claims. 


Paramount Advantage has launched a new member rewards program with the Cincinnati Bengals. Read more about the program here. 


Updated ODM Consent/Certification Forms and Instructions


We partnered with Medicaid plans in Ohio to bring you a Medicaid Resource Guide.


Dawg Pound Healthy Rewards program details for our Paramount Advantage members



Effective March 1, 2018, Paramount Health Care will be changing our claim payment vendor from Change HealthCare to RedCard / VPay. Learn more here. See additional FAQs.


Survey for Advantage PCPs 


Clear Coverage authorization tool is being updated as of 2/1/2018. Please read.


Opioid Prior Authorization updates beginning 1/1/18.


Drug formularies for 2018 are posted on the website.


Commercial Select Formulary Updates as of 11/1/17.


Immediate release opioid prior authorization limits for Paramount Advantage members, effective October 1, 2017. 

8/23/2017 Flu shot information is available for 2017/2018.
6/21/2017 Electronic claim adjustments are now accepted. Please review our announcement for more details.
6/20/2017 Our fax numbers are being updated as of 6/26/2017. Please review our updated fax numbers for Utilization and Care Management.
2/7/2017 Please review the Ohio Department of Medicaid notice regarding ICD-10 diagnosis codes for pregnancy
2/1/2017 The latest updates to the Commercial and Marketplace Formularies are effective March 1, 2017.
12/19/2016 The latest edition of Paramount Network News is available now.
12/1/2016 Paper Claims Submission Policy Update

Paramount regularly reviews and updates our medical payment and claims processing policies. Paramount’s goal is to ensure that the medical payment policies reflect current input from highly respected sources as well as using Paramount’s historical policies. Those respected sources include:

  • CMS’s Medical Coding Policies
  • AMA/CPT Coding Guidelines
  • Local and Regional CMS Policies
  • National Specialty Guidelines (coding and clinical)

Paramount’s medical payment policies focus on areas such as:

  • Bundling Edits including the National Correct Coding Initiative (NCCI)
  • Modifier Usage
  • Global Surgery Policies
  • Multiple Procedure Reduction
  • Units of Service Guidelines
  • Age and Gender Appropriateness

Updated editing will include bundling logic, NCCI edits, modifier usage, global surgery package guidelines, multiple procedure reduction and units of service across claims.

If you have further questions, please contact your Provider Relations Representative at: (419) 887-2535 or (800) 891-2564

10/18/2016 Flu Shot information (removed; please refer to current years information) and Coding/Billing Guide
10/5/2016 IMPORTANT! Prior Authorization requests updates, effective 10/5/2016
9/29/2016 Commercial and Marketplace Exchange Formulary Updates Effective 10/15/2016
8/24/2016 Paramount Advantage formulary updates effective September 2016.
1/25/2016 Attention Labs: Effective April 18, 2016, register clinical laboratories and molecular diagnostic tests in the McKesson Diagnostics Exchange (DEX)
12/11/2015 Check out the 2016 Prescription Drug Formulary & Utilization Management changes for Paramount formularies and drug plans.
11/19/2015 Preferred Drug Lists are now available for 2016.
9/25/2015 Skilled Nursing Pre-Certification Form.
9/2/2015 Flu shot information for 2015/2016 (removed; please refer to current years information)
7/14/2015 The summer edition of Network News is now available.
7/13/2015 ICD-10 is coming soon. Check out our ICD-10 page, and our most recent bulletin on Gesation diagnosis codes for Medicaid.
6/15/2015 Paramount has updated its provider portal. DIRECT has been replaced with MyParamount. Check it out today!
12/23/2014 IMPORTANT! Paramount has a new Pharmacy Benefit Manager effective 1/1/15 - CVS/caremark! Please read this letter for more information.
7/21/2014 Respite Care guidelines for Advantage members.
11/14/2013 Paramount is going electronic – In order to be compliant with ACA requirements to pay providers electronically, all payments made on or after December 13, 2013 will be processed via Electronic Funds Transfer or Virtual Credit Card.
10/22/2013 Synagis FAQ
4/16/2013 Provider Manual - Advantage