Please download the desired form, type in the required information, then email the completed form to OHCProviderRelations@OhioHealthChoice.com. If you are unable to complete online and email, you can choose to submit the form using one of the alternative methods listed on the form.
| Name | Description | |
|---|---|---|
| Interested Practitioner Form | Use this if you are an interested individual practitioner wishing to request to join the Ohio Health Choice network. | Download |
| Interested Facility Form | Use this if you are an interested facilty wishing to request to join the Ohio Health Choice network. | Download |
| Provider Demographic Change Form | Use this to communicate a change to your demographics, such as an address or Tax ID change. | Download |
| Request CPT Reimbursement Amount Form | Use this form to submit up to 15 of your most common CPT codes to determine your reimbursement amount from Ohio Health Choice. | Download |