ODJFS Online | Ohio Medicaid

Job & Family Services Ohio Medicaid

Required Forms & Technical Letters

Medicaid Trading Partner Form
This form gives ODJFS general information about your company (i.e. tax id., contact information, and the transactions you wish to submit / receive).

Medicaid Trading Partner Form

ODJFS Trading Partner Agreements
Submission of the ODJFS Trading Partner Agreement is required to enter into a contractual trading partner relationship with ODJFS. As such, we ask that you follow the directions below when completing it for your organization:

We suggest that your attorney review it.
It is not valid if you amend, redact or change it in any manner.
it must be signed by someone in your organization who is authorized to legally bind the organization.

Download the ODJFS Trading Partner Agreement.

Please sign two originals with blue ink and mail the complete signed documents to:

Ohio Department of Job and Family Services
Office of Contract and Acquisitions
Trading Partner Agreements
30 East Broad Street, 31st Floor
Columbus, Ohio 43215

Call the ODJFS Office of Contracts and Acquisitions at (614) 728-5693 with any questions.

Optional Form for 835 Remittance
Providers and Trading Partners must fill out this form for the Trading Partner to receive the optional 835 remittance advice on behalf of their billing and/or pay-to providers.

ODJFS Designation of an 835 or 834-820 Trading Partner Form

Technical Letters
Medicaid tape billing instructions for National Standard Form (NSF)and Flat File Versions IV and VI: (Note: These are for Sister Agencies only.)