Home
Forms Library
Molina provider contract request

Ohio non par 2025

molina provider contract request Preview on Page 1

See details

4.8 out of 5

260 votes

The document is a Non-Par Provider Contract Request Form for healthcare providers interested in joining Molina Healthcare of Ohio's network. It outlines the necessary information to be submitted, including provider details and practice information, and specifies that separate agreements are needed for non-employed practitioners. Approval will be communicated within 30 days, but submission does not guarantee participation until credentialing standards are met.

Here's how it works

01. Edit your molina provider contract request 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 provider contract request form via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out ohio non par 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 Ohio Non-Par Provider Contract Request Form in the editor.
Begin by entering your Provider Name and Provider Type/Specialty in the designated fields. Ensure accuracy as this information is crucial for your application.
Input your Medicaid ID Number and Practice Name. If you are part of a group practice, list all practitioners' names and specialties on a separate sheet if necessary.
Fill in your Mailing Address and Primary Office Location if it differs from the mailing address. Specify the County where your practice is located.
Provide the name of the Person Completing This Form, along with their Phone number, Provider TIN, and Email Address.
Indicate whether all practitioners are employed physicians of the group by selecting 'Yes' or 'No'. If 'No', be aware that separate agreements will be required for each practitioner.
Include any additional information relevant to your practice in the provided section before submitting.

Start filling out your Ohio Non-Par form today for free using our platform!

See more ohio non par versions

We've got more versions of the ohio non par form. Select the right ohio non par version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (260 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to check Ohio Medicaid claim status?

How can I check on the status of my application? Call our Consumer Hotline at 800-324-8680 or log in to your Ohio Benefits account here to check the status of your application.

How long does it take to hear back from Medicaid Ohio?

States are required by federal law to approve or deny Medicaid applications within 45 days, or 90 days for applications that require a disability determination. However, data weve compiled from more than 500 of our clients nationwide show that states take longer than 45 days to respond.

Which two facility-based waiver programs are administered by the Ohio Department of Aging?

The Ohio Department of Medicaid and the Ohio Department of Aging administer the waivers that require a nursing facility level of care. They include the Ohio Home Care Waiver, PASSPORT Waiver, and Assisted Living Waiver.

What is the phone number for Ohio Medicaid billing?

If youre an Ohio Medicaid member, call our Consumer Hotline at 800-324-8680. Otherwise, follow the links below for additional resources, or complete the Contact Us Form and well get back to you.

Can I check my Ohio Medicaid status online?

Check the status of your coverage using the Ohio Benefits Self Service Portal at benefits.ohio.gov. Update your address on the Department of Medicaid website.

molina healthcare contract request

Ohio non par form pdf Ohio non par forms How do i submit claims to Medicaid in Ohio

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

How to check Medicaid approval status?

Log into your states Medicaid portal Many states have online portals where you can check your Medicaid coverage status. If you already created an account when you applied, log in to see any updates or changes to your status. Look for a section that shows your coverage details or current eligibility.

How do I contact Medicaid in Ohio?

The Ohio Medicaid Hotline is available on Monday through Friday between the hours of 7:00 am and 8:00 pm as well as Saturday between 8:00 am and 5:00 pm at 1-800-324-8680. Online Portal: If you have an Ohio Benefits Self-Service Portal account, you can login and report changes to your contact information.

Who are Ohio Medicaid providers?

Each managed care plan has a member website that you can visit to learn more about their approach to serving Ohio Medicaid managed care members: AmeriHealth Caritas Ohio, Inc. Anthem Blue Cross and Blue Shield. Buckeye Health Plan. CareSource Ohio, Inc. Humana Healthy Horizons in Ohio. Molina HealthCare of Ohio, Inc.

Ohio non par 2025

Here's how it works

How to use or fill out ohio non par with our platform

See more ohio non par versions

Complete this form in 5 minutes or less

Got questions?

How to check Ohio Medicaid claim status?

How long does it take to hear back from Medicaid Ohio?

Which two facility-based waiver programs are administered by the Ohio Department of Aging?

What is the phone number for Ohio Medicaid billing?

Can I check my Ohio Medicaid status online?

Complete this form in 5 minutes or less

People also ask

How to check Medicaid approval status?

How do I contact Medicaid in Ohio?

Who are Ohio Medicaid providers?

molina contract request form

Try more PDF tools