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Required Forms & Technical Letters
The Ohio Department of Medicaid (ODM) requires entities to complete an online application (Medicaid Trading Partner Form) as well as a signed Trading Partner Agreement (TPA) to initiate the process of becoming an authorized trading partner.
Required Forms & Technical Letters

It can take several weeks for the TPA to be routed for approval and signatures within ODM. Once complete, the EDI Support team will notify the contacts provided on the application of the next steps.

Trading Partner Agreement

Submission of the ODM Trading Partner Agreement is required to enter into a contractual trading partner relationship with ODM. As such, we ask that you follow the directions below when completing it for your organization:

  • We suggest that your attorney review this document.
  • 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.
Please download the agreement below:
  • ODM Trading Partner Agreement (Please sign the original with blue ink and email the completed signed document to the email address listed in the agreement. Ensure the document is scanned in color.)

Call EDI Support at (844) 324-7089 with any questions.

Optional Form for 835 Remittance (ODM-06306)

Providers and Trading Partners must fill out the ODM Designation of an 835 or 834-820 Trading Partner Form (Instructions) to receive the optional 835 remittance advice on behalf of their billing and/or pay-to providers.  The preferred method is in an attachment to an email.

Optional Form to post Trading Partner information (ODM-06305)

Trading Partners can fill out an Authorization to Post Trading Partner form if they wish to advertise their services to providers in need of a trading partner. This information is posted on the ODM Trading Partner website.

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).