This version of the form is not currently in use and is provided for reference only. Download this version of Form ODM01718 for the current year.
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.
Q: What is Form ODM01718?
A: Form ODM01718 is the Notice of Denial of Assigned Provider or Pharmacy in the Coordinated Services Program (CSP) in Ohio.
Q: What does this form indicate?
A: This form indicates that a provider or pharmacy has been denied in the Coordinated Services Program (CSP) in Ohio.
Q: What is the Coordinated Services Program (CSP)?
A: The Coordinated Services Program (CSP) is a program in Ohio that provides coordinated and integrated health care services.
Q: Who uses this form?
A: This form is used by providers and pharmacies who have been denied in the Coordinated Services Program (CSP) in Ohio.
Q: What is the purpose of this form?
A: The purpose of this form is to notify providers and pharmacies of their denial in the Coordinated Services Program (CSP) in Ohio.
Form Details:
Download a fillable version of Form ODM01718 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.