What We Do
Plan and Implement
Capital Planning and Management System Transformation Promote
Clinical Quality Coordinating Centers of Excellence Mental Health Promotion and Prevention Ohio Tobacco and Recovery Initiative Research and Evaluation Residency and Traineeship Program Solutions for Ohio's Quality Improvement and Compliance Protect and Monitor
Allocation Guidelines Block Grant Client Rights and Advocacy Community Plans Consumer Outcomes Fiscal Reporting Forms and Templates Legislation Licensure and Certification MACSIS Medicaid Patient Care System Pre-Admission Screening and Resident Review Provide
Assertive Community Treatment Children, Youth and Families Emergency Preparedness Employment Faith Based Initiatives Forensic Services Hospital Services Housing Intensive Home-Based Treatment Older Adults Trauma Informed Care Warehouse and Pharmacy Goods and Services

Forms

• Account Request Form
• Claims Correction Form (Word) (PDF)
  • Claims Correction Form Instructions 
• Disclosure of Information Form (Board Staff)
• HIPAA Service Rate Form (Tier 2)
  • ODADAS Service Codes (Excel) (PDF)
  • ODMH Service Codes (Excel) (PDF)
  • HIPAA Service Rate Form (Tier 2) Instructions 
• MACSIS EDI Claims Testing Request Form (Word) (PDF)
• Member/Claims Transfer Request Form (Word) (PDF)
  • Member/Claims Transfer Request Form Instructions 
• Member Enrollment Form 
  • Member Enrollment Form Instructions 
• Provider Request Modification Form (Word) (PDF)
• Report Request Form 
• Request to Remove Client from MACSIS 
• MACSIS EDI Claims Testing Request Form (Word) (PDF)
• Residency Dispute Determination Form - ADM038 
• Residency Verification Form
• TCP/IP Access Request Form (Unix Accounts)