Provider Manuals & Reimbursement Rates

Manuals
Opioid Treatment Program (OTP) Manual -  Final Version 1.4 12/21/2021 - PDF
Behavioral Health Provider Manual - Final Version 1.24 9/29/2022 - PDF
View released BH Provider Manuals since BH Redesign Implementation

Workbook
BH Coding Workbook Final as of 3/1/2022 - Excel

Medicaid Managed Care Plan Resource Guide (to be updated 12/1/2022)
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 06/28/2021 - Excel

Note: for questions related to OhioRISE, contact OhioRISE@medicaid.ohio.gov

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 (UDT) 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  1/28/2020 - Word

Enrolling Practitioners in Medicaid

Effective October 1, 2022 all provider enrollment applications must be submitted using Ohio Medicaid’s new Provider Network Management (PNM) module. After its implementation, the PNM module will be the single point for providers to complete provider enrollment, centralized credentialing, and provider self-service.

For more information about enrolling as a Medicaid provider, please visit the following link:

https://ohpnm.omes.maximus.com/OH_PNM_PROD/Account/Login.aspx


CBHC Practitioner Enrollment File - As of November 26, 2022

As of 10/15/2022, ODM has resumed production of the CBHC Practitioner Enrollment File.

The National Provider Identifier
The Ohio Department of Medicaid (ODM) requires that providers and practitioners who want to furnish Medicaid covered services to Medicaid recipients enroll as Medicaid providers. This includes both providers and practitioners who will submit claims seeking reimbursement for services furnished to Medicaid recipients and rendering practitioners who are employed by provider groups or organizations who will submit claims to the department for payment.

When enrolling in Medicaid through the ODM Provider Portal health care providers/practitioners must submit to the department the 10-digit National Provider Identifier (NPI) assigned to them by the National Plan and Provider Enumeration System (NPPES).  This 10-digit number is the single identifier required by all public and private health plans. The NPPES website contains instructions for completing an application and fully describes each component of the application process. See links at right.

Taxonomy Code for a National Provider Identifier
When applying for an NPI, providers and practitioners must provide a taxonomy code. The taxonomy code is an alphanumeric code, 10 characters in length. The alphanumeric code is structured into three levels; provider grouping, classification and area of specialization. Taxonomy codes are self-selected by the provider or practitioner completing the NPI application, and providers and practitioners are required to identify at least one taxonomy to associate with their NPI. If more than one taxonomy code is selected, one of the selected codes must be identified as the primary taxonomy. Provider Taxonomy codes and their descriptions can be found on the Washington Publishing Company’s web page.

See information on how to enroll a rendering practitioner in Ohio Medicaid via the PNM, please visit:

https://ohpnm.omes.maximus.com/OH_PNM_PROD/Account/Login.aspx

Resources for Enrolling Practitioners in Medicaid

Enrolling Practitioners with PNM - website
Effective Compliance Programs - PDF
To apply for an NPI - website
For NPI-related questions - website
Health Care Provider Taxonomy - PDF
Provider Taxonomy Codes - website

Billing and IT Resources

Third-Party Liability Resources
Frequently Asked Questions: Medicaid Coordination of Benefits & Third-Party Liability for Community Behavioral Health Centers - 1/22/2020
Third-Party Liability Provider Information Grid by Fee-For-Service & Medicaid Managed Care Plan - 3/31/2021

Additional Resources
Final Services Billable to Medicare and TPL Bypass List - Excel (only for community BH agencies, not applicable to hospital providers) - 3/1/2022
ACT-IHBT - Excel (Effective for date of services prior to 3-1-2022)
ACT-IHBT - Excel (Effective for dates of service on or after 3-1-2022)
ICD-10 DX Code Groups BH Redesign - (Effective for date of services prior to 3-1-2022)
ICD-10 DX Code Groups - (Updated 10-1-2022)
BH Workgroup Limits, Audits and Edits - PDF
Trading Partner Information Guide - PDF
Dual Licensure Grid - Updated as of 03/1/2022 - Excel
Supervisor, Rendering, Ordering Fields - Updated as of 3/1/2022 - Excel

Resources