Provider Manuals, Policies, and Forms
Manuals and guides
AmeriHealth Caritas Ohio offers these reference materials to our providers for use when treating our members.
- Provider manual (PDF)
This manual will help you and your office staff provide services to our members.
If you have any questions, call Provider Services at 1-833-644-6001, or contact your Provider Services Account Executive.
Forms
Ohio Department of Medicaid forms
- Abortion Certification (PDF)
- Acknowledgment of Hysterectomy Information (PDF)
- Aceptación de la Información Sobre Histerectomia (PDF)
- Consent for Sterilization (PDF)
- Consentimiento Para La Esterilización (PDF)
- External Medical Review (EMR) process FAQ (PDF)
- Healthchek and Pregnancy Related Services Information Sheet (PDF)
- Medicaid Advisory Letter and Attestation (PDF)
- Ohio PCP change form (PDF)
- Pregnancy Risk Assessment Communication (PRAF) (PDF)
Submit this form to assist pregnant women in maintaining Medicaid eligibility and to connect them toneeded services and supports, such as home visits. - Report of Pregnancy (ROP) (PDF)
- Substance Use Disorder Residential Treatment Notification of Admission (PDF)
- Substance Use Disorder Services Prior Auth Request (PDF)
AmeriHealth Caritas Ohio forms
- Prior Authorization Request form (PDF)
- Behavioral Health Prior Authorization Form (PDF)
- Provider Contract Inquiry Form (PDF)
- Comprehensive Primary Care (CPC) Program Addendum (PDF)
Policies
Name of policy and link | Implementation date | Post date | Status |
---|---|---|---|
Acupuncture (PDF) | 11/15/2022 | 2/1/2023 (Posted for Go Live) | Active |
Add-On Codes (PDF) | 1/1/2023 | 2/1/2023 (Posted for Go Live) | Active |
Assistant Surgeon (PDF) | 12/1/2022 | 2/1/2023 (Posted for Go Live) | Active |
Bilateral Procedures (PDF) | 12/1/2022 | 2/1/2023 (Posted for Go Live) | Active |
Co-Surgeon (PDF) | 12/1/2022 | 2/1/2023 (Posted for Go Live) | Active |
Diagnosis Code Guidelines (PDF) | 2/14/2023 | 2/1/2023 (Posted for Go Live) | Active |
Diagnosis/Procedure Code Gender Guidelines (PDF) | 2/14/2023 | 2/1/2023 (Posted for Go Live) | Active |
Discontinued Procedure (Modifier 53) (PDF) | 11/15/2022 | 2/1/2023 (Posted for Go Live) | Active |
Distinct Procedural Service (Modifier 59, X{EPSU}) (PDF) | 12/1/2022 | 2/1/2023 (Posted for Go Live) | Active |
Duplicate Claim (PDF) | 11/15/2022 | 2/1/2023 (Posted for Go Live) | Active |
Federally Qualified Health Center (PDF) | 2/14/2023 | 2/1/2023 (Posted for Go Live) | Active |
Global Surgical Package (PDF) | 12/13/2022 | 2/1/2023 (Posted for Go Live) | Active |
Medicaid Reimbursement Policy Overview (PDF) | 12/1/2022 | 2/1/2023 (Posted for Go Live) | Active |
Once-Per-Lifetime Procedures (PDF) | 11/15/2022 | 2/1/2023 (Posted for Go Live) | Active |
Significant-Separately Identifiable Evaluation and Management Service (Modifier 25)(PDF) | 12/1/2022 | 2/1/2023 (Posted for Go Live) | Active |
Telehealth (PDF) | 11/15/2022 | 2/1/2023 (Posted for Go Live) | Active |