Ohio Medicaid

Ohio's Medicaid Program > Providers > ODJFS Trading Partners

Required Forms & Technical Letters

ODJFS Trading Partner Agreement
Submission of the ODJFS Trading Partner Agreement represents a request by a trading partner to enter into contractual 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 here.

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, 31 st Floor
Columbus, Ohio 43215

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

Other Required Forms
All potential trading partners must fill out the following forms: 

1. Medicaid Trading Partner Form
2. 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.)

1. Technical Letter 24G Fee Schedule Specs
2. Technical Letter 28H NSF
3. Technical Letter 29E FFV4 Co-Payment
4. Technical Letter 29E FFV6 Co-Payment

 

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