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This form is used for employers and employees in Ohio to select a state other than Ohio as the exclusive remedy for workers' compensation claims.
This form is used for provider recertification in the state of Ohio. It is used by medical providers to apply for recertification to provide services to patients under the Ohio Bureau of Workers' Compensation.
This document provides information about Healthchek and pregnancy-related services in Ohio.
This document is a form used in Ohio for the Drug Utilization Review Committee Conflict of Interest Policy. It outlines the policy regarding conflicts of interest in the committee.
This form is used for obtaining a certificate that verifies the destruction of data in Ohio. It ensures the secure disposal of sensitive information to protect against data breaches.
This document describes the Conflict of Interest Policy for the Drug Utilization Review Board in Ohio. It outlines guidelines and procedures to prevent conflicts of interest within the board.
This form is used for applying as a Managed Care Entity (MCE) in Ohio and provides options for both out-of-network providers and managed care-only providers.
This form is used for the Pharmacy and Therapeutics Committee in Ohio to disclose and address conflicts of interest among its members. It helps ensure transparency and integrity in the committee's decision-making process.
This Form is used for the Pharmacy and Therapeutics Committee Conflict of Interest Policy for Interested Party Guest Speakers in Ohio.
This Form is used for Ohio residents to declare the medical necessity of bathing seats.
This form is used for designating a trading partner for electronic transactions related to healthcare claims processing in the state of Ohio.
This form is used for referring individuals in Ohio for a review of their continuing eligibility for Medicaid.
This form is used for requesting prior authorization for substance use disorder services in Ohio.