Providers certified to deliver Medicaid Services are assigned a Medicaid number necessary to obtain federal reimbursement. Once certified, providers are responsible for contacting local County Boards of Mental Retardation and Developmental Disabilities (County Boards of MRDD) to advise them of their certification status.
Initial Certification – Supported Living - Medicaid Funded Services
If you are interested in being a certified Medicaid waiver provider, you must complete all of the following standard Medicaid enrollment forms, and the waiver service application for the service you wish to be certified to provide. Located and listed on the bottom of each application are requirements that must be submitted with your application as documentation of meeting certification standards (i.e., BCII, training, etc.)
If you are an organization applying for certification, complete the Ohio Health Plan Provider Enrollment Application/Agreement for an Organization, titled ODJFS – 6751.
If you are applying as an individual provider, complete the Ohio Health Plan Provider Application/Agreement for Individual Practitioners, titled ODJFS –6750.
ODJFS 6751 – Organizations
ODJFS 6750 – Individual Practitioners
Authorization Agreement for Direct Deposit of State Warrants