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Reviewing Healthcare. Improving Quality.





                                                                                            Click Here to register for Ohio Medicaid Precertification     

Ohio Medicaid

Since 1985, we have partnered with the Ohio Department of Job and Family Services (ODJFS) and its predecessors to review, improve, and assure quality of care and appropriateness of services delivered to Ohio's Medicaid recipients.

Quality and Utilization Management Program



We assist ODJFS in continuously monitoring and improving the quality and appropriateness of hospital services. Our contracted services include: precertification of inpatient and outpatient elective procedures; retrospective medical necessity review of hospital services; and focused quality and utilization improvement studies. These studies incorporate data collection and analysis, feedback sessions with providers, and development of strategies to improve care.

Newsletters and Precertification Manual are available in portable document format (.pdf). In order to view, you will need the Adobe Acrobat Reader. It is available for download at no charge from Adobe Systems Incorporated. The Ohio Medicaid Precertification Manual has been developed to give Ohio hospitals and providers the latest information regarding what procedures require precertification, who to call for precertification, and the information necessary to perform a precertification. Click below for the most recent version.



Procedures Requiring Precert Effective 10/1/06

Using the Online Precertification Manual

Ohio Medicaid Precertification Manual, revised 3/3/11
Ohio Medicaid Change of Contact Form
The Ohio Department of Job and Family Services Medicaid Web Site
Ohio Medicaid Contact Reference Guide

Email Contact Information Form



Questions or inquiries regarding the Ohio Medicaid Retrospective Review Program can be sent to Service Line Manager  Managers Sue Butterfield  or Review Supervisor Ralene McNeal. Send an Email

For questions about provider claims, please call ODJFS at 1-800-686-1516.

In addition, we publish the Ohio Medicaid Quality Monitor, a quarterly newsletter, to help communicate review trends and project information to the doctors, hospitals, and health plans that serve Ohio Medicaid clients.

Download or view the
Ohio Medicaid Quality Monitors

Studies in Progress

All current studies in process assist ODJFS in evaluating the use and costs of medical procedures and therapies; assess the appropriateness of various care settings; assist in the design or evaluation of the efficacy of interventions to change patient or provider behavior; and contribute to the development of systems for coordinating care across settings. Current studies focus on:

  • Comparison of Hospital and Physician Procedure Codes 

Click here for information on recently completed studies.

 



Please call Dennis Gramlich, our Ohio Contract Administrator, at (800) 473-0802 or contact us electronically.  GO


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