buckeye health plan waiver Preview on Page 1

Provider instructions 2026

The document provides instructions for providers interested in becoming MyCare Home and Community-based Service Providers with Buckeye Health Plan. It outlines the certification process, necessary documentation, and steps to obtain a Medicaid Provider Number. The process includes background checks, completion of a first aid class, and submission of specific forms such as the Home and Community-Based Provider Information Form and W-9 form. It emphasizes the importance of having the appropriate certifications for the services offered and details the timeline for becoming a contracted provider.

Here's how it works

01. Edit your buckeye health plan waiver online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send buckeye waiver via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out provider instructions with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click 'Get Form' to open the Home and Community-Based Provider Information Form in the editor.
Begin by entering your personal details, including your last name, first name, and date of birth. Ensure accuracy as this information is crucial for processing.
Fill in your agency name and Tax ID number. If applicable, indicate whether you submit claims to Morning Star of Ohio by checking the appropriate box.
Provide your National Provider Identifier (NPI) and Ohio Medicaid Provider number if available. This step is essential for verification purposes.
Select your provider type (independent or agency) and certifying agency. Include the date of certification to complete this section.
Check all HCBS Waiver Services you are certified to provide. Be specific about the services listed to ensure compliance with requirements.
Indicate the counties where you intend to provide services for Buckeye members by checking the relevant boxes.
Once all fields are completed, review your entries for accuracy before submitting the form through our platform.

Start filling out your provider instructions today for free using our platform!