Payor Resources


Ohio Health Choice PPO Network

Ohio Health Choice is Ohio's first Preferred Provider Organization (PPO) network. It was incorporated in 1982 by the Sisters of Charity of St. Augustine with the goal of developing a vehicle to offer quality, cost effective care to the members of their community. Ohio Health Choice continues to be 100% provider owned by Summa Health System of Akron and Mercy Medical Center of Canton.

Ohio Health Choice employs a partnership approach to the delivery of health care in order to improve quality while reducing costs. Ohio Health Choice relies on selective contracting with Participating Providers and Facilities for our networks, financial incentives in Payors' medical benefit plans to encourage patient participation, and appropriate use of medical resources. The cooperation enjoyed between Ohio Health Choice, its providers, and its clients helps to provide quality health care services for the employers and their employees.


Sales Resources

The account management staff at Ohio Health Choice is available to support your sales personnel on a daily basis. Our associates are prepared to assist your brokers with potential client presentations, new employer orientations and other marketing or sales needs.

The following sales and marketing tools are available, upon request, at Ohio Health Choice. Please provide your written request specifying type and volume needed, allowing for a reasonable turnaround time. You can call 800-554-0027 and choose Sales and Account Management or ask Customer Service to transfer the call to the Sales and Account Management Department.

  • Zip Code Accessibility, commonly referred to as a GEO report
  • Provider Disruption based upon a claim file (file specifications will be provided)
  • Potential Savings Analysis

New Business Notification

Payors must communicate information on new employer groups accessing network products. This form must also be used to communicate amendments to or termination of current employer groups. Accurate and timely completion of this form will ensure appropriate implementation of the group's program. Please review the Ohio Health Choice Network Product Description to ascertain which network product your client will be accessing. If further clarification is required please contact Ohio Health Choice.

PROCEDURE:

  1. Completion of an Ohio Health Choice New Business Notification (NBN) form is required for each employer group accessing a specific Ohio Health Choice product. Your account manager will provide assistance in the completion of this form. The completed NBN should be submitted to the Ohio Health Choice Account Management department at least 15 days prior to the proposed effective date.
  2. This form must also be completed for any amendments or revisions. Terminations must be communicated in writing to Ohio Health Choice.
  3. A policy, group or plan number must be assigned to all employer groups. This number must be noted on the insured's I.D. card.
  4. An employer agreement is also required if the life count of the group is 50+ lives.
  5. NBN forms are available by calling 800-554-0027 and choosing Sales and Account Management, or by contacting your Sales Representative directly.
Payor Manual

The Payor Manual contains detailed information about Ohio Health Choice, and the interactions between Payors, Network Providers and Ohio Health Choice. Click below to download the most recent version of the Ohio Health Choice Provider Manual.

Download
Ohio Health Choice - Payor Manual

Download Ohio Health Choice Provider Demographic Files

Full Provider Demographic Files, along with their associated layouts, are posted monthly to the Ohio Health Choice FTP site. Please call 800-554-0027 and choose Sales and Account Management to set up FTP acccess to the demographic files.


Electronic Data Interchange (EDI)

Ohio Health Choice prefers to send and receive claims electronically, and is able to implement an EDI connection with any payor who also desires to use EDI for claims transmission. Please click here for more detailed information regarding EDI with Ohio Health Choice. You may also call 800-554-0027 and choose Sales and Account Management to start the EDI implementation process.