On June 30, 2024, the Ohio Department of Medicaid (ODM) identified several issues with the fee-for-service (FFS) prior authorization submission in the Provider Network Management module in conjunction with the Fiscal Intermediary. These issues made it difficult for providers to obtain an FFS prior authorization.

While ODM has resolved some of these issues, we understand work still needs to be done with the prior authorization submission process to resolve the problems fully. As a result, ODM is lifting the prior authorization requirements. This decision applies to claims that would require prior authorizations with service dates as of June 30, 2024. ODM and our vendor partners will correct the issues as quickly as possible. We will send a notice before reinstating the prior authorization requirement along with the timeframe for reinstatement.

If your service is custom and does not have a fee schedule price, contact the ODM Integrated Helpdesk at 800-686-1516, option 1.

The Ohio Department of Medicaid is conducting a series of MyCare Ohio program community input sessions to hear about your experiences navigating the current MyCare Ohio program, other Fully Integrated Dual-Eligible Special Needs plan (FIDE-SNP) models, and the members you serve. If you currently provide services through MyCare Ohio or are interested in becoming a MyCare Ohio provider, please join us during one of our upcoming sessions.

To learn more about the MyCare Ohio program and community input sessions and view the schedule, please visit the MyCare Ohio program webpage.