Medicaid Managed Care Plan Resource Guide (to be updated on a regular basis)
Ohio Medicaid MyCare and traditional managed care plans have developed a comprehensive resource guide identifying individuals who will serve as points of contact for provider inquiries regarding MCP operations, billing, prior authorization, and pharmacy.
Information Grid as of 6/28/2021 - Excel
Medicaid/MyCare Uniform Prior Authorization Form
The Ohio Managed Care and MyCare plans have developed a uniform prior authorization form for community BH services.
Uniform PA Form Updated 6/16/2020 - PDF
Ohio Urine Drug Testing Prior Authorization Request Form
ODM and OhioMHAS, in collaboration with the Medicaid MCPs, have released a standard UDT PA form available for use by behavioral health community providers to request PA for UDT that exceeds the guidelines that became effective July 1, 2019.
Standard UDT PA Form 9/9/2019 - Word
Review of ASAM Criteria for Managed Care Plan Prior Authorization Reviewers
The Ohio Department of Medicaid, in collaboration with Mercer Consulting, held a webinar on June 29, 2018, to review American Society of Addiction Medicine (ASAM) history and criteria, walk through certain scenarios, discuss the utilization management process, and connect with the MCPs on their responsibility to review prior authorization requests.
View the webinar
Prior Authorization Webinar on IHBT and ACT
On June 13, 2018, ODM and OhioMHAS, in partnership with Case Western Reserve University and KEPRO, delivered a webinar on performing prior authorization for Intensive Home Based Treatment (IHBT) and Assertive Community Treatment (ACT) for Medicaid Managed Care Plans. Webinar topics included: an overview of the two programs, eligibility criteria, lessons learned thus far, and additional discussion items.
View the webinar | View the slides | View IHBT scenarios | View ACT scenarios
Ohio Medicare and Medicaid recipients enrolled in a MyCare Ohio plan receive community behavioral health services through their MyCare Plan. For additional information on MyCare Ohio, please see: http://medicaid.ohio.gov/FOROHIOANS/Programs/ManagedCare/MyCareOhio.aspx.
MyCare Ohio Map - PDF
Substance Use Disorder Services Prior Authorization Request Form
The Ohio Managed Care and MyCare plans have developed a uniform prior authorization form for SUD services that require prior authorization.
SUD PA Form - 9/2021