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Provider Enrollment
Resources for enrolling as an Ohio Medicaid provider.
Provider Enrollment

Important Updates

Attention Providers Who Wish to Assess Children/Youth for the OhioRISE Program!

As of May 2,the Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS) Information Technology (IT) System is available for all certified Ohio Children’s Initiative CANS assessors to begin conducting CANS assessments with a child/youth. The new OhioRISE program will use the Ohio Children’s Initiative CANS tool to establish eligibility and to inform care planning and decision-making for children and adolescents with behavioral health needs. Certified Ohio Children’s Initiative CANS assessors are expected to use the CANS IT System to gather all information about the child/youth and family story to describe their strengths and needs. 

There are actions that you must take in order to use the CANS IT System to conduct CANS assessments with a child/youth and to bill Medicaid for CANS assessments beginning July 1, 2022. 

  • Click here to view the CANS Resources page of the OhioRISE webpage, where you will find guidance for obtaining Ohio Children’s Initiative CANS certification, billing for CANS assessments, and accessing the CANS IT System. 
  • If you plan to bill Medicaid, the OhioRISE plan, or Medicaid managed care organizations for CANS assessments, you must be an enrolled Medicaid provider and add the “ORC – CANS Assessor” specialty to your enrollment. Click here to view the OhioRISE Provider Enrollment and Billing Guidance.

Attention Waiver Providers with Ohio Departments of Developmental Disabilities and Aging

The Ohio Department of Developmental Disabilities (DODD), the Ohio Department of Aging (ODA), and providers of state plan services through the Ohio Department of Medicaid (ODM) are required to obtain a National Provider Identifier (NPI) and keep it on file with ODM – in accordance with Ohio Administrative Code 5160-1-17.

Federal law requires that an NPI be used to identify providers on any standard transaction (such as a claim) for health care services. Since waiver services are paid in part using federal Medicaid funds, you must obtain an NPI and update your records with ODM to include your NPI.

To assist waiver providers in complying with this requirement, please review the following documents found atop this page.

    • National Provider Identifier Requirements – ODM Letter for Waiver Providers (September 2020)
    • National Provider Identifier and Taxonomy Guidance for Providers of Department of Developmental Disabilities (DODD) Waiver Services (September 2020)
    • National Provider Identifier and Taxonomy Guidance for providers of Ohio Department of Aging (ODA) Waiver Services (September 2020)


New Services are being added to Ohio Home Care Waiver

Effective July 1, 2019, three new home and community-based services (HCBS) will be available to individuals enrolled on the Ohio Home Care Waiver. The new services are Community Integration, Community Transition and Home Maintenance/Chore. To find out more about the services and determine if or how you can become a provider. Click here for more information.

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 (ODM) – Visit: https://ohiohcbs.pcgus.com 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

Change in background checks for Ohio Home Care Waiver providers

Ohio Department of Medicaid (ODM) is moving to a new system that will eliminate the need for Ohio Home Care Waiver non-agency providers to do an annual criminal records check. Over the next several months, we will be switching to RAPBACK or Retained Applicant Fingerprint Database. This new process will provide ODM continuous information about a person’s criminal history. As a result, providers will no longer have to pay for a background check. ODM will automatically enroll providers into RAPBACK and there is no cost to the provider. There are a few people that will have to complete one more background check before they can be enrolled in RAPBACK. If you have any questions, please contact the Provider Hotline at 1-800-686-1516.

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, which can be found by clicking on the "Medicaid Provider" tab.

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