Forms, billing and reference guides
Frequently requested provider forms and guides
- Ohio nursing facility request form
- Ohio primary care physician (PCP) change form
- Ordering, Referring, Prescribing (ORP) Providers and Procedures
- Pregnancy risk assessment form (PRAF)
- Synagis respiratory syncytial virus (RSV) form
- UnitedHealthcare Plan of Ohio interactive quick reference guide
- UnitedHealthcare Community Plan of Ohio prior authorization resources
ICD-10 tips
The Ohio Department of Medicaid (ODM) ICD-10 team will post monthly ICD-10 tips, which will offer clarification and guidance to ODM providers and ODM staff on the transition to the ICD-10 codes. The following links will take you to ODM resources concerning the ICD-10 transition.
Submit a pre-service appeal and/or grievance for a Medicaid member