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Cheat Sheets and FAQs

Claims

  • APUPD Process
  • BRULE Explanation 
  • Claims EDI File Processing for the 837P 
  • Contracts and Pricing Flowchart 
  • Contract, PSCHD & Procedure Code Tables 
  • Correcting MACSIS Medicaid Claims Priced Using Tiered Payment Logic
  • Correcting OHIO Claims - MBRIN 
  • Correcting OHIO Claims - PRVIN 
  • Creating/Terming Contracts in Diamond
  • Creating/Terming Non-Medicaid Contracts/Rates in Diamond
  • Denying a Claim
  • Denying Claims Beyond Submission Deadline
  • FAQ - Claims
  • Fixing Retroactive Medicaid-Eligible Claims 
  • Making a Denied Claim Payable
  • Putting a Claim on Hold
  • Reporting Third Party Insurance on the 837P
  • Reversing a Claim
  • Sample 835 v4010 NPI File 
  • Sample 837P v4010 NPI File 
  • Life Cycle of a Claim Flowchart
  • Life Cycle of a Claim Documentation
  • Splitting a Claim
  • Un-Pending Claims

Timelines

  • AOD OHEXT/CPE Process Timeline
  • APUPD Process Timeline
  • MH OHEXT/CPE Process Timeline
  • Claims Process Timeline  

Member

  • Completing the Member Screen 
  • Enrolling a Client
  • FAQ - Electronic Eligibility Inquiry
  • FAQ - Member
  • FAQ - Member & Medicaid Eligibility
  • Residency Determination Cheat Sheet
  • Search for a Member

Related Information

  • MACSIS Naming Conventions
  • MACSIS Reports List

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On this page...

  • Claims
  • Timelines
  • Member
  • Related Information

REGIONAL PSYCHIATRIC HOSPITALS LICENSURE AND CERTIFICATION PROCUREMENT AND DISTRIBUTION
At six state hospital locations, ODMH
delivers comprehensive care to people in
need of intensive inpatient treatment.
ODMH has regulatory authority over providers
of mental health services that operate in
community or private hospital settings.
ODMH provides wholesale pharmaceuticals
and food items in addition to a complete
line of pharmacy services.
Contact the Ohio Department of Mental Health | Site Map | Privacy Notice
John R. Kasich, Governor | Tracy J. Plouck, ODMH Director | Ohio.gov | Office of Health Transformation