Provider Manuals, Policies, and Forms
Manuals and guides
AmeriHealth Caritas Ohio offers these reference materials to our providers for use when treating our members.
- Provider manual (PDF)
This manual will help you and your office staff provide services to our members.
If you have any questions, call Provider Services at 1-833-644-6001, or contact your Provider Services Account Executive.
Forms
Ohio Department of Medicaid forms
- Abortion Certification (PDF)
- Acknowledgment of Hysterectomy Information (PDF)
- Aceptación de la Información Sobre Histerectomia (PDF)
- Consent for Sterilization (PDF)
- Consentimiento Para La Esterilización (PDF)
- External Medical Review (EMR) process FAQ (PDF)
- Healthchek and Pregnancy Related Services Information Sheet (PDF)
- Medicaid Advisory Letter and Attestation (PDF)
- Ohio PCP change form (PDF)
- Pregnancy Risk Assessment Communication (PRAF) (PDF)
Submit this form to assist pregnant women in maintaining Medicaid eligibility and to connect them toneeded services and supports, such as home visits. - Report of Pregnancy (ROP) (PDF)
- Report of Pregnancy (ROP) Submission and Billing Instructions (PDF)
If unable to submit electronically, mail or fax the form to the member's local county JFS office. - Substance Use Disorder Residential Treatment Notification of Admission (PDF)
- Substance Use Disorder Services Prior Auth Request (PDF)
AmeriHealth Caritas Ohio forms
- Prior Authorization Request form (PDF)
- Physician Administered Medication Prior Authorization Request form (PDF)
- Behavioral Health Prior Authorization Form (PDF)
- Provider Contract Inquiry Form (PDF)
- Comprehensive Primary Care (CPC) Program Addendum (PDF)
Transportation forms
- Non-Emergency Medical Transportation Ohio Facility Direct Scheduling Option Affidavit (PDF)
- Ohio Non-Emergency Medical Transportation Facility Direct Scheduling Option for Transportation Providers (PDF)