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Synagis Prior Authorization Form: To assist in simplifying the prior authorization process for Synagis, the 7 Medicaid Care Coordination Plans have developed a Synagis Prior Authorization Form with criteria based on the 2009 American Academy of Pediatrics Red Book Guidelines.

Rx Prior Authorization Form

MCP Pharmacy Reference Guide / Preferred Drug List (PDL)

Prenatal Risk Assessment

Early Periodic Screening and Diagnostic and Treatment (EPSDT) brochure including diagnosis codes. EPDST Well Child Visit Checklist Documents:

Standardized Medicaid Prior Authorization information:          

• A grid comparing all 5 Medicaid plans' requirements
• Prior authorization instruction sheet
• Prior authorization standardized form that all plans use

Medicaid FAQ:
Read provider-specific FAQs relative to Medicaid in Ohio.
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Provider specific benefit explanations:
Learn about the benefits providers receive from Medicaid Care Coordination plans.
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Nursing Facility Stay Form:
Review instructions and fill out the review form for nursing facility stay.
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Home Health Approval Form:
Our new Home Health Prior Authorization form.
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*** For Provider Complaint Forms, please go to the Medicaid Care Coordination Plan's website by clicking a logo below.