Form ODM10273 Voluntary Termination of Ohio Medicaid Provider Agreement - Ohio

Form ODM10273 Voluntary Termination of Ohio Medicaid Provider Agreement - Ohio

What Is Form ODM10273?

This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is ODM10273?
A: ODM10273 is a document for the voluntary termination of an Ohio Medicaid Provider Agreement in Ohio.

Q: What is the purpose of ODM10273?
A: The purpose of ODM10273 is to provide a form for healthcare providers in Ohio to voluntarily terminate their Medicaid Provider Agreement.

Q: Who can use ODM10273?
A: Healthcare providers in Ohio who wish to voluntarily terminate their Medicaid Provider Agreement can use ODM10273.

Q: Is ODM10273 mandatory?
A: No, ODM10273 is a voluntary form, and healthcare providers are not obligated to use it.

Q: What information is needed to complete ODM10273?
A: To complete ODM10273, healthcare providers need to provide their name, provider ID, termination effective date, reason for termination, and a signature.

Q: What happens after submitting ODM10273?
A: After submitting ODM10273, the Ohio Department of Medicaid will process the termination request and update the provider's status accordingly.

Q: Are there any consequences to terminating a Medicaid Provider Agreement?
A: Terminating a Medicaid Provider Agreement may affect the provider's ability to participate in the Medicaid program and receive reimbursement for services.

Q: Can a provider reapply for a Medicaid Provider Agreement after termination?
A: Yes, a provider can reapply for a Medicaid Provider Agreement after termination, but the Ohio Department of Medicaid will review the application and make a determination based on their policies and guidelines.

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Form Details:

  • Released on April 1, 2021;
  • The latest edition provided by the Ohio Department of Medicaid;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form ODM10273 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.

Download Form ODM10273 Voluntary Termination of Ohio Medicaid Provider Agreement - Ohio

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  • Form ODM10273 Voluntary Termination of Ohio Medicaid Provider Agreement - Ohio, Page 1
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