Home and Durable Medical
Equipment Providers
The Prior
Authorization/Prospective Review Area
The Prior
Authorization/Prospective Review Area ensures that all
Medicaid services requiring prior authorization are medically
necessary and appropriate; evaluates and prices (when necessary) PA
requests for medical, transportation, durable medical equipment,
organ transplantation, supplies, and dental and vision
services.
Billing Concerns: Ohio
Medicaid providers may contact the Interactive Voice Response (IVR)
system for billing concerns. The IVR is available 24-hours,
seven-days a week. Call 1-800-686-1516.
Notice Regarding Incontinence
Garments: Effective January 1, 2010, the Medicaid
DME benefit coverage of incontinence garments (disposable diapers,
liners and underwear/pull-ups and diaper service including
T4521-T4535 and T4538) for adults changed from 300 per month to 200
a month. Please note that incontinence codes T4535 and T4538 are
also subject to these parameter changes and that clarifying
revisions to the Medicaid Supply List OAC rule 5101:3-10-03 will be
updated at the earliest opportunity.
Please remember:
- Do not submit PA requests before checking the warranty for
covered repairs on wheelchair repairs. Medicaid cannot reimburse
providers for warranty-covered wheelchair repairs. Maintain HIPAA
compliance, by always referring to NAS PDAC when selecting codes
for all DME. The use of incorrect codes will result in denials
- When requesting enteral
nutrition products remember:
- 1) One unit equals 100 calories, and
- 2) Deduct the amount provided by the Women, Infants and
Children (WIC) Program
- Use miscellaneous codes (e.g., E1399, K0108) for unique
items when there is no applicable or available HCPCS
code.
PA Turnaround Time:
PA requests are reviewed according to the
date received in the Initial (or PA Review) Queue. The turnaround
time is improved when submitted supporting documentation
(Certificate of Medical Necessity) is accurately completed,
legible, and signed and dated by the appropriate medical
professional(s).
Do not submit duplicate PA
Requests. Submitting duplicate requests will delay
turnaround time.
Helpful Links:
Forms for DME/HME
are listed below:
JFS 01902 | Certificate of Medical
Necessity/Prescription Mechanical Ventilators |
JFS 01903 | Certificate of Medical
Necessity/Prescription IPPV or APAP in Lieu of a Volume
Ventilator |
JFS 01904 | DME Repairs |
JFS 01905 | Certificate of Medical
Necessity/Prescription Compression Garments |
JFS 01907 | Certificate of Medical Necessity/Enteral
Nutrition Therapy |
JFS 01909 | Certificate of Medical Necessity -
Oxygen Therapy |
JFS 01910 | Certificate of Medical
Necessity/Prescription Blood Glucose Monitor (Glucometer) and
Supplies |
JFS 02904 | Decubitus Care/Pressure Reducing
Surfaces |
JFS 02910 | Hospital Beds |
JFS 02929 | Pneumatic Compression Devices |
JFS 03401 | Certificate of Medical
Necessity/Prescription Pulse Oximeter |
JFS 03402 | Certificate of Medical
Necessity/Prescription Transcutaneous Electrical Nerve Stimulator
(TENS) |
JFS 03411 | Custom/Power Wheelchairs |
JFS 03414 | Manual Wheelchairs w/o Custom
Seating |
JFS 03523 | Request for Rx Prior
Authorization |
JFS 07134 | Certificate of Medical
Necessity/Prescription Osteogenesis Bone Stimulators |
JFS 07136 | Certificate of Medical
Necessity/Prescription External Infusion Pump |
JFS 07137 | Certificate of Medical Necessity Home
Care Certification |