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Ohio Department of Medicaid INSTRUCTIONS FOR COMPLETING ODM 06653, MEDICAL CLAIM REVIEW REQUEST Instructions for completing this form: This form is not to be used for routine claim submission and/or.

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Starting January 1, 2018, behavioral health providers will be able to bill Evaluation and Management (E&M) Codes. This code set consists of CPT codes 99201 – 99205 and 99211-99215. This change will apply to ALL mental health and substance use disorder treatment providers qualified to bill Ohio Medicaid.

Call our Consumer Hotline at 800-324-8680 or check your Medicaid eligibility at Ohio Benefits here.

Requests for PA can be made by using the PA forms available at http://pharmacy.medicaid.ohio.gov/prior-authorization and faxing them to 1-800-396-4111. PAs are also accepted over the phone at 1-877-518-1546.

If you're an Ohio Medicaid member, call our Consumer Hotline at 800-324-8680....Contact Us. Medicaid ConsumersMedicaid ProvidersOther InquiriesCall the Consumer Hotline 1-800-324-8680Visit the Provider PageContact your county office4 more rows

Medicaid Billing No. - Enter patient's Medicaid twelve (12) digit billing number.

Choice Counselors are available at 1-800-324-8680 to answer your questions Mon-Fri 7am-8pm and Sat 8am-5pm ET.

Once an application has been submitted, you can go to the Medicaid Provider Portal to check the status. From the providers home page select the Registration ID of interest. Once you select the registration id link you will be taken to the ”Provider Management Home” page.

The Ohio Medicaid Payer ID (receiver Id) is MMISODJFS.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232