** Please be advised that the Integrated Helpdesk will be closed on Wednesday, November 11, 2026, in observance of Veterans Day. Pharmacy and Sandata EVV help desks are excluded from the Holiday closure and will remain open.
Attention! Mandatory training for Qualified Entities that perform presumptive eligibility determinations
If you are a Qualified Entity as defined in rule 5160:1-1-01 of the Administrative Code, your provider administrator and all agents authorized to perform presumptive eligibility determinations are required to attend an upcoming training to maintain access to the Presumptive Eligibility Portal. Please visit https://medicaid.ohio.gov/resources-for-providers/billing/presumptive-eligibility-training/ to register for an upcoming training session. Training sessions will begin November 12 and go through November 20.
Ordering, Referring, and Prescribing (ORP) Requirements for Managed Care
The Ohio Department of Medicaid (ODM) is preparing for the January 1, 2027 implementation of Ordering, Referring, and Prescribing (ORP) requirements for Managed Care Entities (MCEs).
As part of this effort, Ohio Administrative Code Rule 5160-1-17.9 is being updated to clarify the application of ORP requirements to MCEs. Beginning January 1, MCEs will adjudicate ORP-related claims and will pay or deny claims based on whether ORP requirements apply and have been met.
For additional information, review:
Ohio Medicaid Launches Statewide Provider Revalidation Initiative
Ohio Medicaid is conducting a federally directed, statewide revalidation of all Medicaid providers to support and strengthen program integrity efforts. All providers will be required to complete revalidation within a 24-month cycle. Please watch for your official notice to begin the revalidation process. For more information, visit the Strengthening Program Integrity webpage.
In addition, Ohio Medicaid is reviewing provider agreements for possible termination when there has been no claim activity for two or more years. If a provider agreement is terminated, Ohio Medicaid will send an official notification to the provider.
Important: Moratorium on Enrollment of Home Health and Hospice Providers
Effective May 14, 2026 through November 14, 2026: In accordance with CMS-6101-N and 42 CFR 455.470, the Ohio Department of Medicaid (ODM) is implementing a moratorium on the enrollment of Home Health and Hospice providers.
During this period, ODM will not accept new Medicaid enrollment applications for Hospice or Home Health Agencies, Waiver Individuals and Organizations, Private Duty Nurses, Personal Care Aides and Home Care Attendants. In accordance with OAC 5160-1-17.6(G)(28), any application for the following provider types submitted prior to May 14, 2026, but not yet processed by the Department will be denied. Impacted applicants will receive notice of the application denial. Applicants are welcome to reapply if and when the moratorium is no longer in effect. Existing enrolled providers of these types may continue to operate however no new service locations will be added during this time. Demographic changes and revalidations will still be processed.
16 – Other Accredited Home Health Agency
25 – Non-Agency Personal Care Aide
26 – Non-Agency Home Care Attendant
38 – Private Duty Nurse (Registered Nurse and Licensed Practical Nurse)
44 – Hospice
45 – Waivered Services Organization
55 – Waivered Services Individual
60 – Medicare Certified Home Health Agency