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  • Odm01913

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ODM 01913 (7/2014). Formerly JFS 01913 (11/2011). Ohio Department of Medicaid. CERTIFICATE OF MEDICAL NECESSITY/PRESCRIPTION. GENERAL .

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All in-patient services require prior authorization. Please call 1-800-488-0134Navigate to tel:1-833-230-2101Navigate to tel:1-833-230-2101Navigate to tel:1-833-230-2101 to obtain prior authorization for emergency admissions. Outpatient emergency services do not require prior authorization.

Advanced Imaging Prior Authorization Ordering physicians must obtain prior authorization for the following outpatient, non-emergent diagnostic imaging procedures: MRI/MRAs. CT/CTA scans.

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

Enteral Nutrition may be medically necessary for dietary management to provide sufficient caloric and nutrition needs as a result of limited or impaired ability to ingest, digest, absorb or metabolize nutrients; or for a special medically determined nutrient requirement.

If you're a provider, call our Provider Hotline at 800-686-1516. If you're an Ohio Medicaid member, call our Consumer Hotline at 800-324-8680.

Income & Asset Limits for Eligibility 2023 Ohio Medicaid Long-Term Care Eligibility for SeniorsType of MedicaidSingleMarried (both spouses applying)Income LimitIncome LimitInstitutional / Nursing Home Medicaid$2,742 / month*$5,484 / month*Medicaid Waivers / Home and Community Based Services$2,742 / month†$5,484 / month†1 more row • Jan 6, 2023

To be eligible for coverage, you must: Be a United States citizen or meet Medicaid citizenship requirements. Your local county Job and Family Services office can help to explain these requirements and can help get you enrolled. Have or get a Social Security number. Be an Ohio resident. Meet financial requirements.

Read the application carefully. Attach copies of your proof of income, resources (such as cash, savings, checking, real property, stocks, bonds, etc.), proof of citizenship or alien status, pregnancy if applicable, and other insurance you may have.

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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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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