ODJFS Online | Ohio Medicaid

Job & Family Services Ohio Medicaid

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