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
Ohio Department of Medicaid Inpatient Psychiatric Precertification 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.