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)
• Healthchek and Pregnancy Related Services Information Sheet (PDF)
• Medicaid Advisory Letter and Attestation (PDF)
• Pregnancy Risk Assessment Communication (PRAF) (PDF)
  
  Submit this form to assist pregnant women in maintaining Medicaid eligibility and to connect them to
  needed services and supports, such as home visits.
• Prior Authorization Request Form (PDF)
• Report of Pregnancy (ROP) (PDF)

AmeriHealth Caritas Ohio Forms

• Provider Contract Inquiry Form (PDF)
• Comprehensive Primary Care (CPC) Program Addendum (PDF)

Policies

• Add-On Codes (PDF)
• Assistant Surgeon (PDF)
• Bilateral Procedures (PDF)
• Co-Surgeon (PDF)
• Distinct Procedural Service (Modifier 59, X{EPSU}) (PDF)
• Medicaid Reimbursement Policy Overview (PDF)
• Significant-Separately Identifiable Evaluation and Management Service (Modifier 25) (PDF)