Provider 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.
Joining the Ohio Health Choice Provider Network
Ohio Health Choice invites providers to join the network based on a variety of factors, including specialty, geographic location, and continuity of care. If you would like to request to join our network of high quality providers, please download and type in the required information on the appropriate form below, then email to OHCProviderRelations@OhioHealthChoice.com for consideration. If you are unable to fill out online and email, you can choose to submit the form using one of the alternative methods listed on the form.
| 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 facility wishing to request to join the Ohio Health Choice network. | Download |
Updating your Demographic Data
Please use the form below to send demographic data updates to Ohio Health Choice. Download the form and type in the required information, then email to OHCProviderRelations@OhioHealthChoice.com. If you are unable to fill out online and email, you can choose to submit the form using one of the alternative methods listed on the form.
| Provider Demographic Change | Download |
Provider Manual
The Provider Manual contains detailed information about Ohio Health Choice, and the interactions between providers and Ohio Health Choice. It includes information regarding claim submission guidelines, credentialing requirements, and billing guidelines. Providers should consult the Provider Manual to ensure the best experience while providing quality medical care to our members. Click below to download the most recent version of the Ohio Health Choice Provider Manual.
Download
Request CPT Reimbursement Amounts
Please use the form below to submit CPT codes to determine reimbursement amounts. Download the form and type in the required information, then email to OHCProviderRelations@OhioHealthChoice.com. If you are unable to fill out online and email, you can choose to submit the form using one of the alternative methods listed on the form. (Note that new codes issued by Medicare each year for providers contracted under the Ohio Health Choice fee schedule will default to 106% of current Medicare fees.)
| Request For CPT Reimbursement Amounts | Download |
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 above. For benefit issues, please contact the payer located on the ID card. For a list of payers, their websites, and their phone numbers, see Payor List below.
Payor List
Ohio Health Choice works with many Third Party Administrators (TPA) and insurance companies.
Click Here for a complete list of payors with associated websites and phone numbers.
Understanding ID Cards
Because Ohio Health Choice works with many different payors, member insurance ID cards will vary.
Click Here for a general explanation of the important information on ID cards.
Physicians' and Practitioners' Credentialing Rights
Ohio Health Choice (OHC) has the responsibility to ensure that payer members receive only the highest quality care from individuals on its panel. One way OHC accomplishes this is by credentialing and recredentialing its providers. Your responsibility as an 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;
- 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 the Provider Manual.