Important Enrollment Update
New background check requirement for owners of agencies (3/29/16)

As mandated in the 42 CFR 455.410 and 455.434, the Ohio Department of Medicaid (ODM) now requires criminal records checks of individuals associated with organizations enrolling to become Medicaid providers. Applicants will be notified by mail if a background check is required.

The background check is required for home health agencies, durable medical equipment providers, wheelchair van providers, and waiver services organizations. Any individual who is either a managing employee of a Medicaid provider organization or maintains 5 percent or greater direct or indirect ownership interest of a Medicaid provider agency is also subject to a background check.

Background checks must be completed by the Bureau of Criminal Identification and Investigation.  An individual that resides outside of Ohio can complete a criminal background check conducted by the FBI. Individuals who have not lived in Ohio for the last five years, must also complete a FBI check

A complete list of BCI WebCheck vendors is available here.

New Requirement for Providers who Order, Refer, or Prescribe Only

Beginning January 2014, providers who are not enrolled with Ohio Medicaid, but order, refer or prescribe items or services for Medicaid beneficiaries will need to enroll with the Ohio Department of Medicaid.   Billing providers will be required to list the ordering, referring or prescribing information on their claims, or their claims will be denied in the near future.
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Attention Waiver Services Provider Applicants!

Prior to submitting an application, waiver provider should contact the following for enrollment requirements and assistance:

  • For the Ohio Home Care Waiver or the Transitions Carve-out waiver (ODM) – Visit: for application and enrollment information or contact PCG at (877) 908-1746.  Note: Bureau of Criminal identification & Investigation (BCI&I) reports for initial provider enrollments ONLY should be sent to:  The Ohio Department of Medicaid, Attention: BCII Coordinator, P.O. Box 183017, Columbus, Ohio 43218-3017

Providers Subject to On-Site Screening Visits

Federal and state laws require some providers to have pre- and post-enrollment on-site screening visits to ensure program integrity. (See OAC 5160-1-17.8 – formerly OAC 5101:3-1-17.8 for additional information about provider screening requirements).

In Ohio, the Public Consulting Group, Inc. (PCG) will conduct these visits for providers that are not already screened by another state or federal agency.   On-site screening visits are conducted without prior notification or appointment.  The PCG representatives will have a business card and a letter of introduction, for your verification.

When the PCG representatives arrive at your office, please take a few moments to answer their questions and allow them access to your facility.  This will help to complete your on-site visit smoothly.   During your site visit, the PCG representatives will review various aspects of your business.  Failure to answer their questions and cooperate with the PCG representatives could affect your enrollment or current provider status with Ohio Medicaid.

Provider Disclosure Requirements
Federal and state regulations require all Medicaid providers to disclose full and complete information regarding individuals or entities that own, control, represent or manage them. This requirement applies to all provider types that are either enrolling or revalidation as an Ohio Medicaid provider – regardless of business structure (large corporation, partnership, non-profit or other type of business organization). Providers must disclose the information for owners (direct and indirect), members of Boards of Director and managing employees – this information includes an individual’s Social Security number and date of birth. Ohio Department of Medicaid disclosure requirements are outlined in OAC 5160-1-17-3. Warning: Do not try to bypass this requirement by entering in a fake Social Security number, because the computer system will automatically reject the application
Direct Deposit

To receive payments via direct deposit, please complete the Direct Deposit Authorization Agreement.

For additional information please contact:
Provider Enrollment Unit
P.O. Box 1461
Columbus, Ohio 43216-1461