NOTE FOR OHIOHEALTH CIN PROVIDERS: Much of the information in this FAQ applies to independent providers and while the terms of timely filing and appeals do apply, you will not receive the amendment referenced. For more information on what this means to you as a CIN provider please contact your CIN representative.
Yes, the OhioHealthy secure provider portal is called Provider Connection. Through Provider Connectionour portal, you can verify member eligibility and benefits, submit authorizations, and view claims and payment status. Provider Connection The OhioHealthy Provider Portal is available to contracted OhioHealthy providers and requires registration.
You can access eligibility, benefits and claims information by logging into the OhioHealthy Provider Portal. You may also contact us by calling Provider Services at (844) 853-4060.
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.
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 submitting an OhioHealthy Physician Office Change Form
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.
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 Credentialing Services at ohiohealthcredentialing@ohiohealth.com to receive an application.
The credentialing process typically takes approximately 90 days from the time we receive a complete application.
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 an executed contract.
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.
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 emailing OhioHealthCredentialing@OhioHealth.com.
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.
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 Change Healthcare.
Medical and Behavioral Health:
OhioHealthy can also accept electronic claims directly from providers who are able to submit an ANSI 837 file.
Use payor ID# 48116
OhioHealthy Claims
PO Box 4278
Clinton, IA 52733-4278
365 days from the date of service. This includes any reconsiderations and appeals.
You can view claims status and view your payment remits on the OhioHealthy Provider Portal Provider Connection or by calling Provider Services.
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.
Yes. Please complete and submit the Electronic Enrollment Form.
ACH/EFT is safe, secure, and efficient. Funds are typically deposited 24 hours after payments are processed. Once enrolled for EFT, you will no longer receive paper payments, and can choose how you would like to receive your remittance.
Pursuant to the Billing section of your Participating Provider Agreement with OhioHealthy, Providers shall submit claims on the appropriate claim form as determined by OhioHealthy for all Covered Services within three hundred sixty-five (365) days of the date those services are rendered.
All claims for services rendered for dates of service in calendar year 2023 not submitted within 365 days, and by 12/31/24, will be denied for payment and Provider shall hold OhioHealthy, the applicable Beneficiary, and the Payor financially harmless for the payment of such claims. If you are a Provider with additional questions please email us at providerrelations@ohiohealthyplans.com. If you are a member with additional questions please email us at Inquiry@ohiohealthyplans.com.
OhioHealthy does not require referrals from primary care to specialty care, however; individual specialists may require your referral before treatment.
Please ensure your directory profile and your information is accurate. If your provider directory profile is incorrect or needs to be updated, please complete the OhioHealthy Provider Change form as soon as possible.
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 or contact Provider Services. 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.
Please contact Provider Services 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 Services to initiate our provider appeal process.
Web-based access to OhioHealthy's medical plan information including:
Any healthcare providers or staff (i.e., physicians, clinicians, office staff) that may require access to member information such as eligibility, claim status, authorization status, and/or OB authorization creation.
Follow the steps below:
Call the number on the back of any OhioHealthy member’s ID card.
Monday - Friday, 8:30 a.m. to 5 p.m. EST