Medicaid Client Intake Form
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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
Call the Integrated Helpdesk at 800-686-1516.
1?800?686?1516 The Ohio Medicaid Provider Services Interactive Voice Response System (IVR) provides 24-hour,7-day a week access to information regarding provider application status, Consumer eligibility, provider-group affiliation, claim status, payment status and provider information.
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.
What is Ohio Medicaid Act 52? A provision by Ohio Medicaid to allow Medicaid residents in a health care facility to satisfy outstanding medical expenses incurred prior to Medicaid approval. How Does Ohio Medicaid Act 52 Work? debt is paid.
We are here to help! Consumer Hotline 800-324-8680.
For assistance with submitting prior authorizations, contact the ODM Integrated Help Desk (IHD) at 1-800-686-1516.
How do I add my newborn to my Medicaid case? Call our Consumer Hotline at 800-324-8680 or log in to your Ohio Benefits account here to check the status of your application.
