Home and Durable Medical Equipment Providers

The Prior Authorization (PA) / Prospective Review Area ensures that all Medicaid services requiring prior authorization are medically necessary and appropriate; evaluates and prices (when necessary) PA requests for medical, transportation, durable medical equipment, organ transplantation, supplies, and dental and vision services.
Fax: 1-614-752-8387

Ohio Medicaid providers may contact our Interactive Voice Response (IVR) system for billing concerns. The IVR is availaible 24-hours, 7-days a week. Call: 1-800-686-1516.

Things to remember:

• For all Pediatric and/or Healthchek PA requests, please indicate "CHILD" on the top of form JFS 03142

• When submitting PA requests for wheelchair repairs, look at the warranty to determine if it is a covered repair.  Providers cannot bill Medicaid for covered repairs

• To maintain HIPAA compliance, always refer to SADMERC when selecting codes for all DME.  The use of incorrect codes will result in denials
  

1. When requesting Enteral Nutrition products remember:
   1. 1) one unit equals 100 calories and
   2. 2) deduct the amount provided by the Women, Infants and Children (WIC) Program

1. Miscellaneous Codes (e.g., E1399, K0108) are for truly unique items for which there is no applicable or available HCPCS code  

The total turn around time for PA request processing is based on receipt of accurately completed, legible, Prior Authorization Request (JFS 03142 ), including all appropriate documentation and required Certificates of Medical Necessity. PA Requests are reviewed on a first-in/first out basis, according to the date received by the Prior Authorization Unit. Please do not send duplicate PA Requests. Submitting duplicate requests will prolong response time.