Frequently Asked Questions

This page contains answers to frequently asked questions on a variety of topics. You may select a topic or question below, or simply scroll down to read all of the questions and answers.

Important note: Answers to common questions are general guidelines for most health plans offered by OhioHealthy. While most of the answers apply to all plans offered by OhioHealthy, there may be some slight differences. Please refer to your plan materials or contact us for information.

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General Questions

  • Does OhioHealthy have online tools for providers?

    Yes, the OhioHealthy secure provider portal is called Provider Connection. Through Provider Connection, you can verify member eligibility and benefits, submit authorizations, and view claims and payment status. Provider Connection is available to contracted OhioHealthy providers and requires registration.

    Register for Provider Connection

  • Who can I contact if I have questions about claims, member benefits, eligibility, or plan participation?

    You can access eligibility, benefits and claims information by contacting Provider Services at 1 (844) 853.4060. or through Provider Connection (available 24 hours a day) or by calling Provider Relations.

    If you need to confirm that you are a participating provider in your patient's OhioHealthy plan, you can use our directory to search for your provider profile. The "Plans Accepted" tab reflects the plans that you are currently contracted to accept as an in-network provider. You may also contact Provider Relations at 1 (877) 865.9075, option 4 for this information.


Provider Updates/Changes

  • What do I need to do if I am changing my practice information?

    Please notify OhioHealthy as soon as possible of any changes to practitioner or practice information. Provider updates can take up to 30 days to process, so please submit your request at least 30 days prior to the desired effective date of your change to avoid interruption/loss of reimbursement.

    You may submit your changes by contacting Provider Services at 1 (844) 853.4060 or submitting a OhioHealthy Physician Office Change Form.

  • I am leaving one practice and joining another. Do I need to credential again?

    No, but you must notify OhioHealthy within at least 30 days of leaving your previous practice. If notification is more than 30 days from the time you have left your previous practice, it may be necessary for you to go through the credentialing process again.

    If you are moving to a solo practice or to a group who is not currently contracted with OhioHealthy, a new contract must be executed before you are able to rendering services under the new tax ID as an in-network provider.


Credentialing/Plan Participation

  • How can I become an OhioHealthy Provider?

    Providers interested in participating in the OhioHealthy network should complete, and submit the appropriate credentialing Application Packet. OhioHealthy utilizes the CAQH (Council for Affordable Healthcare) application for our credentialing process. Please ensure completion of your CAQH application before submitting an application packet to OhioHealthy.

    Please contact Network Contracting and Credentialing Services at 1 (800) 455.4460 or 1 (614) 566.0056 to receive an application.

  • How long does the credentialing/application process take?

    The credentialing process typically takes approximately 90 days from the time we receive a complete application.

  • Do I need to sign a contract?

    If you are joining a solo practice than a executed contract is required before we can begin the credentialing process. Contract requirements are dependent on how the practice you are joining is contracted, this will determine your need for a executed contract.

  • How will I know when my application has been approved?

    You will receive a Welcome Letter from Network Contracting welcoming you to the network, advising you of your OhioHealthy effective date. Once you have received this notice and have enrolled in Provider Connection, you may begin seeing members on an in-network basis.

  • How can I check the status of my application?

    If it has been more than 90 days since you submitted your complete application, and you have not been sent a Welcome Letter informing you of your participation, you may contact the Credentialing department at OhioHealthy to verify participation by calling 1 (800) 455.4460 or 1 (614) 566.0056.

  • Can I begin seeing OhioHealthy members before I am credentialed (during the contracting/application process)?

    You must wait until you have received confirmation from OhioHealthy that you are a participating provider before providing services to OhioHealthy members on an in-network basis. Services provided prior to your OhioHealthy effective date may not be reimbursed. If your patient has out-of-network benefits, you may be able to provide services prior to becoming credentialed, however, this may result in a higher cost to your patient. Please always be sure to verify the member's benefits before providing services.


Claims

  • Can I submit my claims electronically?

    Yes. Electronic submission is the preferred method of claims submission. Providers who file electronically benefit from documentation of claims transmission, faster reimbursement, reduced claims suspensions and lower administrative costs. Providers can submit claims electronically through any clearinghouse that can connects through Allscripts/PayerPath.

    OhioHealthy Health Payer IDs:
    Medical and Behavioral Health: 54154

    OhioHealthy can also accept electronic claims directly from providers who are able to submit an ANSI 837 file. 

  • What is the address for submitting paper claims?

    OhioHealthy Claims
    PO Box 5806
    Troy, MI 48007-5806

  • What are the timely filing limits for claim submission?

    365 days from the date of service. This includes any reconsiderations and appeals.

  • How can I check the status of my claims?

    You can view claims status and view your payment remits on Provider Connection or by calling Provider Relations at 1 (877) 865.9075, option 4.

  • How do I submit my claim for reconsideration?

    Reconsiderations/corrected claims submitted on a paper CMS 1500 form should include the word "Reconsideration" in field 19 to prevent misidentification of the reconsideration as a duplicate claim. Reconsiderations can also be submitted electronically. Please contact your clearinghouse to find out the specific requirements for submitting a reconsideration.

    Medical Providers may also submit reconsiderations online through Provider Connection by selecting "Medical Claims," selecting the claim in question, and choosing the "Reconsider Claim" option. Providers are able to make corrections online to CPT coding, diagnosis, billed charges, quantity and/or place of service.

  • Can I receive my reimbursements by EFT/direct deposit?

    Yes. Please complete and submit the Electronic Enrollment Form.

    Direct deposit is safe, secure, and efficient. Funds are typically deposited 24 hrs. after payments are processed. Once enrolled for EFT, you will no longer receive paper remits, and can access your remits through Provider Connection or from your clearinghouse. Please ensure you are registered for Provider Connection before enrolling in EFT — register for Provider Connection.

    If you are not a participating provider with OhioHealthy, you will need to obtain your remits through your clearinghouse or by calling Provider Relations  1 (877) 865.9075, option 4.


Referrals

  • Does OhioHealthy require referrals?

    No. OhioHealthy does not require referrals.

  • How can I increase the likelihood of receiving referrals?

    Most of our members access the online provider directory to locate a provider best suited to their needs (location, office hours, areas of focus, populations seen, etc.). Maintaining an accurate directory profile, including your availability, specialties, and areas of focus is the best way to ensure members have the opportunity to access your services.

    Please review your directory profile to ensure your information is accurate. If your provider directory profile is incorrect or needs to be updated, please contact your Network Educator as soon as possible.


Lab

  • What reference labs do I send my lab work to?

    Providers have the option of sending the patient with orders to a participating draw site. A list of draw sites is available by using the online provider directory. Members having surgery at a participating hospital can be sent directly to the admitting hospital with a prescription for pre-operative testing or a participating reference lab.


Appeals/Complaints

  • What if I have a complaint?

    Please contact Provider Relations at 1 (877) 865.9075, option 4 to discuss the matter. We will make every effort to resolve the matter quickly and informally. If, however, you are not satisfied with the outcome, you may contact Provider Relations to initiate our provider appeal process.