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Home & Durable Medical Equipment Providers
Technical assistance and prior authorization information for durable medical equipment providers
Home & Durable Medical Equipment Providers

The Prior Authorization/Prospective Review Area

The Prior Authorization/Prospective Review Area ensures that all Medicaid services requiring prior authorization are medically necessary and appropriate; evaluates and prices (when necessary) PA requests for medical, transportation, durable medical equipment, organ transplantation, supplies, and dental and vision services.

Billing Concerns

Ohio Medicaid providers may contact the Interactive Voice Response (IVR) system for billing concerns. The IVR is available 24-hours, seven-days a week. Call 1-800-686-1516.

Please Remember

Do not submit PA requests before checking the warranty for covered repairs on wheelchair repairs. Medicaid cannot reimburse providers for warranty-covered wheelchair repairs. Maintain HIPAA compliance, by always referring to NAS PDAC when selecting codes for all DME. The use of incorrect codes will result in denials.

When requesting enteral nutrition products remember:

  • One unit equals 100 calories, and
  • Deduct the amount provided by the Women, Infants, and Children (WIC) Program
  • Use miscellaneous codes (e.g., E1399, K0108) for unique items when there is no applicable or available HCPCS code

PA Turnaround Time

PA requests are reviewed according to the date received in the Initial (or PA Review) Queue. The turnaround time is improved when submitted supporting documentation (Certificate of Medical Necessity) is accurately completed, legible, and signed and dated by the appropriate medical professional(s).

Do not submit duplicate PA requests.  Submitting duplicate requests will delay turnaround time.