Ohio Network Affiliation Agreement
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How to fill out Network Affiliation Agreement?
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FAQ
In Ohio, you can register as a transportation provider if you provide the state's medicaid office with documentation, such as your driver's license; a vehicle maintenance report; and a written backup plan in the event that your vehicle breaks down. You also have to pass a drug screening and a competency test.
For the most part, to be eligible for Medicaid you must be one of the following: Be age 65 or older. Have a permanent disability as that term is defined by the Social Security Administration. Be blind.
Federal timeliness standards to determine eligibility are 90 days for customers with a disability and 45 days for all other customers. Ohio Admin.
Family Size Monthly Income* 1 $1,823 2 $2,465 3 $3,108 4 $3750 5 $4,393 6 $5,035 7 $5,678 8 $6,320 9 $6,963 10 $7,605 Families with monthly incomes higher than the amount in the first column, but lower than the amount in the second column MUST apply if they do not have private health insurance.
Apply for Medicaid in Ohio Eligibility: Adults are eligible with incomes up to 138% of poverty. Children are eligible with incomes up to 206% of poverty, and pregnant women are eligible with incomes up to 200% of poverty.
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.
1, providers will utilize the new Provider Network Management (PNM) module to access the MITS Portal. Through this link, providers can submit and adjust fee-for-service claims, prior authorization requests, hospice applications, and verify recipient eligibility.
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. Otherwise, follow the links below for additional resources, or complete the Contact Us Form and we'll get back to you. Where is my card?