About Ohio Health Choice


Please click on the link for a list of Ohio Health Choice Payers: Ohio Health Choice Payers



OHIO HEALTH CHOICE - PROVIDER MANUAL

PROVIDER MANUAL


NPI SUBMITTAL FORM | NPI SUBMITTAL FORM
PDF version to fax/mail | Word document to email

For more information about the National Provider Identifier (NPI) and how to apply, go to the CMS Website



Request Fee Reimbursement Amounts

Please submit 10-20 of your most used codes along with your fee and tax identification number. Fax this to the attention of Provider Relations at 330-996-8211. Requests will be returned that are missing this information. Thank you!


Appeal Process

Pursuant to the OHC Facility and Provider agreements, if providers have an issue with a claim that needs to be reviewed for interpretation or application of the agreement terms, providers can contact our customer service at: 1-800-554-0027 to initiate the claims appeal process. For additional details please see the provider manual which is located below. For benefit issues, please contact the payer located on the ID card. For a list of payers, their websites, and their phone numbers, click Ohio Health Choice Payers


Physicians’ and Practitioners’ Credentialing Rights

Ohio Health Choice (OHC) has the responsibility to assure that payer members receive only the highest quality care from individuals on its panel. One way OHC accomplishes this is by credentialed and recredentialed its providers according to stringent standards established by the National Counsel for Quality Assurance (NCQA) and the Ohio Revised Code (ORC). Your responsibility, as a Ohio Health Choice physician or practitioner includes timely submission of all credentialing and re-credentialing information upon request.

OHC also has the responsibility to its physicians and practitioners to ensure they are notified of their credentialing rights. As an OHC physician or practitioner, you have the right to:

• Strict confidentiality of all information obtained during the credentialing process;

• Nondiscrimination during the credentialing and recredentialing processes;

• Be notified of information obtain during the credentialing process that varies substantially from what is submitted by you;

• Review information submitted to support your credentialing application, with the exception of references, recommendations, or other peer-review protected information;

• Correct erroneous information submitted by another source;

• Be informed of the status of your credentialing application upon request by contacting the Credentialing Department at (330) 996-1783.

• Receive notification of the initial credentialing decision within 60 days of the Credentialing Committee decision.

For further details on all your rights as an OHC physician/practitioner please review your Provider Manual. You many also review the provider manual on our website at: PROVIDER MANUAL




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