Authorizations

For urgent and emergent pre-authorizations, call the number on the back of the member’s ID card.

Authorization status is available by calling Provider Services via the number on the back of the member’s ID card.

Medical Authorizations

Drug Authorizations

All drugs paid under medical coverage, please use the medical authorization form above. The exception would be specialty drugs that are required to go through Archimedes for OhioHealth Associates.

Behavioral Health Authorizations

Hospital Review Team


Elective admissions/requests should be submitted for pre-authorization as soon as possible or at least 7-10 days prior to scheduling an admission or procedure.

For urgent and emergent pre-authorizations, call the number on the back of the member’s ID card.

Authorization status is available by calling Provider Services via the number on the back of the member’s ID card. Providers are also notified of all authorization decisions in writing (by fax). Elective decisions are typically rendered within 4-5 days from receipt of all requested information. Urgent cases will be completed within 72 hours.

Emergency requests due to life-altering situations will be completed within 24-48 hours.

Important! 2021 Claims Runout Extended to June 30, 2022

IT IS IMPORTANT THAT OUR CLAIMS DEPARTMENT RECEIVES ALL CLAIMS FOR THE CALENDAR YEAR 2021 NO LATER THAN JUNE 30, 2022.

ALL CLAIMS PROCESSING INCLUDING INITIAL CLAIMS, CORRECTED CLAIMS, APPEALS AND RESUBMISSIONS NEED TO BE RECEIVED BY THIS TIME IN ORDER TO ENSURE THEY CAN BE FULLY PROCESSED. FAILURE TO DO SO COULD RESULT IN DELAYED PROCESSING

2021 claims submission:

The EDI number for electronic submission of 2021 claims is 54154
The mailing address for 2021 paper claims is P.O. Box 5806, Troy, MI 48007-5806

2022 claims submission:

The EDI number for electronic submission of 2022 claims is 34158
the mailing address for 2022 paper claims is P.O. Box 2582, Hudson, OH 44236-2582

Questions?

Send an email to: ProviderRelations@OhioHealthyPlans.com.

Providers