Provider Resources & Forms
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.
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
Read provider-specific FAQs relative to Medicaid in Ohio.
Home Health Approval Form:
Our new Home Health Prior Authorization form.
*** For Provider Complaint Forms, please go to the Medicaid Care Coordination Plan's website by clicking a logo below.