OH Medicaid

Hospital Utilization Management Program

Permedion provides the following services in support of the ODM’s Hospital Utilization Management Program:

  • Prior authorization for med-surg hospital, home health and behavioral health services
  • Pre-certification of psychiatric inpatient admissions
  • Retrospective hospital reviews, including inpatient psychiatric hospitalization
  • Focused reviews as determined by ODM for specific provider’s claims or medical records
  • Healthcare studies

Prior Authorization Form: Increased State Plan Home Health Services
Prior Authorization Provider Instructions: Increased State Plan Home Health Services
Nusinersen (Spinraza) Cover Letter
Nusinersen (Spinraza) Prior Authorization Form

CONTACTS

For questions regarding this vendor transition, please contact:

  1. ODM Provider Helpline: 1-800-686-1516,
  2. Hospital Med-Surg Retrospective Reviews: Lowell Webb, RN, ODM-SURS Clinical Review Supervisor; Email: Lowell.Webb@medicaid.ohio.gov; Phone: 614-752-5700,
  3. ODM-SURS Hospital Appeals:
  4. SURS Hospital Appeals – Provider Line: 1-866-841-0002
  5. SURS Hospital Appeals – Fax Line: 1-614-644-2217
  6. SURS Hospital Appeals – Fax by email: Bacs_fax@medicaid.ohio.gov
  7. SURS Mailing Address: Ohio Department of Medicaid, Surveillance and Utilization Review Section, PO Box 182582, Columbus OH, 43218-2582
  8. HMS Permedion:
  9. Home Health Prior Authorization Submissions, Fax: 1-855-474-4306, ***Please note during the start-up beginning 12/1, current templates/form will be accepted***
  10. Behavioral Health and Inpatient Psych Authorization Questions, Phone: 1-855-974-5393,
  11. Medical-Surgical Hospital and Home Health Prior Authorization Questions, Phone: 1-800-772-2179
  12. Email address for all provider contacts: ODMUR@HMS.com

 

Additional information will be distributed by ODM and posted to our website.