Odm 09401 form 2026

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Definition & Meaning

The ODM 09401 form is a document utilized by the Ohio Department of Medicaid. It plays a critical role in the administrative process of tracking nursing facility residents’ admissions and discharges. This form is pivotal in ensuring that Medicaid administers accurate and timely updates regarding resident movements within the facilities. Each section of the form caters to capturing essential details such as resident information, facility details, and submission particulars, which collectively aid in seamless reporting and documentation.

How to Obtain the ODM 09401 Form

Obtaining the ODM 09401 form is straightforward. Individuals or facilities can access the form through the Ohio Department of Medicaid’s official website. The form is available for download in a printable PDF format, ensuring easy accessibility and distribution. Moreover, you can obtain this form through direct contact with administrative offices at Medicaid-participating nursing facilities. If you encounter any issues, contacting the Ohio Department of Medicaid directly or visiting their local offices can provide additional support and guidance.

How to Use the ODM 09401 Form

To effectively use the ODM 09401 form, it is imperative to follow a systematic approach:

  1. Resident Information: Begin by filling out the resident’s personal details, including full name, Medicaid ID, and date of birth.

  2. Facility Information: Specify the details of the nursing facility, such as the facility’s name and identification number.

  3. Admission/Discharge Details: Clearly indicate whether the form pertains to a new admission or a discharge. Include relevant dates and any supporting details pertinent to the resident’s status change.

  4. Submitter Information: Provide comprehensive details of the individual completing the form, including contact information for any follow-up queries or clarifications.

Ensuring accuracy in every section is crucial for the form’s effective processing and minimizes potential delays in updating Medicaid records.

Steps to Complete the ODM 09401 Form

Completing the ODM 09401 form involves several detailed steps, which can be outlined as follows:

  1. Download or Obtain the Form: Ensure you have the latest version of the form either downloaded or in hardcopy.

  2. Gather Required Information: Before filling out the form, compile all necessary details about the resident and the facility.

  3. Section-by-Section Completion:

    • Resident Details: Input accurate personal data.
    • Facility Details: Document the facility’s identifying information.
    • Admission/Discharge Information: Accurately detail the admission or discharge particulars, including dates and notable conditions.
    • Submitter Details: Fill in the submitter’s section with your personal information ensuring all contact details are correct.
  4. Review and Verify: Double-check all the sections to avoid any discrepancies that could impact the reporting process.

  5. Submission: Follow the specified method for submitting the form, whether online or through the designated mail channels.

Who Typically Uses the ODM 09401 Form

The ODM 09401 form is primarily used by Medicaid-participating nursing facilities in Ohio. Administrative staff or designated personnel within these facilities typically manage and complete the form to ensure resident admissions and discharges are reported accurately to the Ohio Department of Medicaid. In addition, healthcare coordinators and case managers involved in the oversight of Medicaid services may also interact with this form to maintain compliance and proper records of resident status.

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Key Elements of the ODM 09401 Form

Critical elements embodied in the ODM 09401 form include:

  • Resident Information: Captures basic personal and identification details.
  • Facility Information: Outlines specifics about the nursing facility.
  • Admission and Discharge Sections: Essential for documenting the type and relevant dates of change in residency status.
  • Submitter Information: Ensures contact points are available for form queries or corrections.

Each field within these sections must be filled with precision to support effective Medicaid administration.

Legal Use of the ODM 09401 Form

The legal use of the ODM 09401 form is centered on its role in complying with Medicaid regulations. Nursing facilities are mandated to report admissions and discharges through this form to maintain transparency and accountability in Medicaid services. The accurate filing of this document helps prevent fraudulent reporting and coordinates with state health regulations to keep Medicaid operational standards intact.

Examples of Using the ODM 09401 Form

Consider a nursing facility that receives a new resident under Medicaid coverage. Upon admission, the administrative staff would complete an ODM 09401 form to inform the Ohio Department of Medicaid about this new entry. Similarly, when a resident is discharged, another ODM 09401 form is submitted to indicate the departure from the facility, updating the resident’s status. These examples underscore the form’s utility in managing resident records accurately under Medicaid’s purview.

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If you have already registered in the MITS portal, you can access the secure portal and proceed to submit your claims. Submitting claims through the MITS portal is free. If you need assistance call the Medicaid Provider Call Center at 1-800-686-1516 We urge you to act now to ensure future payment of your claims.
To apply for Medicaid, you will need: Proof of identity, like a photo ID, birth certificate or passport. Social Security card, or proof that you have applied for one. Proof of your immigration status if you are not a citizen.
The five levels of assisted living include: Level 1: Independent living. Level 2: Assisted living. Level 3: In-home care. Level 4: Memory care. Level 5: Skilled nursing care.
A level of care determination is a decision made about an individuals physical, mental, social, and/or emotional status. In Ohio, there are two primary levels of care: nursing facility and developmental disabilities levels of care.
What tools are used to determine level of care needs? Formal tools for assessing the level of care someone needs include: The Katz Index of Independence in Activities of Daily Living. In this assessment, one point is gained for each ADL a person can complete independently.

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Standards of care shall be defined as what an ordinary, reasonable professional with similar training would have done in a similar circumstance.
Care Coordination Care coordination is provided by Aetna the OhioRISE plan or a care management entity (CME) in the young persons community. Depending on a child or youths needs, they will receive one of three levels or tiers of care coordination.
Please do not use Humanas traditional payer ID for fee-for-service claims (61101) when submitting Humana Healthy Horizons Medicaid claims. Claims must be submitted electronically. Paper claim submission is not accepted for Ohio Medicaid.

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