Ohio Department of Medicaid Forms

Este formulario se utiliza para solicitar programas combinados en Ohio.

This form is used for standard authorization in the state of Ohio.

This form is used for acknowledging the terms and conditions governing the presumptive eligibility determinations authority granted by the Ohio Department of Medicaid to a qualified entity in Ohio.

This document is used for notifying Medicaid Estate Recovery in Ohio about a pending transfer of property through a Transfer on Death Deed.

This form is used for authorizing skilled tasks for home care attendants (HCA) in Ohio. It allows HCAs to perform specific skilled tasks while providing care at home.

This form is used for authorizing home care attendants in Ohio to administer medication to patients.

This form is used to request private duty nursing services in the state of Ohio.

This form is used for assessing the private duty nursing (PDN) services in the state of Ohio. It helps in determining the needs and eligibility of individuals for PDN care.

This form is used for submitting a medical claim review request in the state of Ohio. It provides instructions on how to complete and submit the form accurately.

This Form is used for verifying eligibility for Medicaid in Ohio. It serves as a checklist for the required documents needed for the review process.

This Form is used for requesting approval for Ohio Health Plans Letter templates in Ohio.

This form is used for requesting Medicaid Home and Community-Based Services (HCBS) waiver in Ohio.

This form provides information about Healthchek and pregnancy-related services in Ohio.

This form is used for updating provider information in Ohio.

This form is used for obtaining a Certificate of Medical Necessity specifically for Insulin Pumps in the state of Ohio.

This form is used for obtaining a certificate of medical necessity for lactation pumps in the state of Ohio. It is necessary for individuals who require a lactation pump for medical reasons.

This form is used for voluntarily terminating an Ohio Medicaid Provider Agreement in Ohio.

This form is used for obtaining a certificate of medical necessity for hospital beds and bed accessories in the state of Ohio. It ensures that the bed and accessories are necessary for the patient's medical condition.

This form is used for obtaining a Certificate of Medical Necessity for oxygen therapy in the state of Ohio.

This form is used for requesting a certificate of medical necessity for osteogenesis stimulators in the state of Ohio.

This Form is used for requesting a Certificate of Medical Necessity for Pneumatic Compression Devices and Accessories in the state of Ohio.

This form is used for applying for a Certificate of Medical Necessity for therapeutic footwear for individuals with diabetes in the state of Ohio. It helps individuals get the necessary footwear to manage their condition.

This form is used for obtaining a Certificate of Medical Necessity for pressure-reducing support surfaces in the state of Ohio.

This form is used for certifying the medical necessity of Transcutaneous Electrical Nerve Stimulation (TENS) units in Ohio.

This Form is used for obtaining a Certificate of Medical Necessity in the state of Ohio, specifically for Speech-Generating Devices.

This form is used for certification of the necessity of non-emergency transportation by ground ambulance in the state of Ohio.

This form is used for certifying Ohio Medicaid managed care encounter data in the state of Ohio.

This form is used for Ohio counties to respond to Medicaid Quality Control (MEQC) case findings.

This form is used for obtaining a Certificate of Medical Necessity for Positive Airway Pressure Devices in the state of Ohio.

This Form is used for applying for a Certificate of Medical Necessity for hearing aids in the state of Ohio.

This form is used for obtaining a certificate of medical necessity for pulse oximeters in the state of Ohio.