Required Forms & Technical Letters
Important Notice to prospective Trading Partners
In preparation for the new Medicaid Information Technology System (MITS) we have temporarily suspended the enrollment of new trading partners with the Ohio Department of Job and Family Services. You may continue to send the Required Forms for enrollment (Medicaid Trading Partner Form aka the Profile and the ODJFS Trading Partner Agreement) but ODJFS will not be assigning any new trading partner numbers or allowing testing to begin until the new MITS has been successfully implemented.
Please visit the MITS website often for important updates and information at: http://jfs.ohio.gov/mits/index.stm
Medicaid Trading Partner Form
This form gives ODJFS general information about your company (i.e. tax id., contact information, and the transactions you wish to submit / receive).
ODJFS Trading Partner Agreements
Submission of the ODJFS Trading Partner Agreement is required to enter into a contractual trading partner relationship with ODJFS. As such, we ask that you follow the directions below when completing it for your organization:
Download the ODJFS Trading Partner Agreement.
Please sign two originals with blue ink
Ohio Department of Job and Family Services
Office of Contract and Acquisitions
Trading Partner Agreements
30 East Broad Street, 31st Floor
Columbus, Ohio 43215
Call the ODJFS Office of Contracts and Acquisitions at (614) 728-5693 with any questions.
Optional Form for 835 Remittance
Providers and Trading Partners must fill out this form for the Trading Partner to receive the optional 835 remittance advice on behalf of their billing and/or pay-to providers.
Technical Letters
Medicaid tape billing instructions for National Standard Form (NSF)and Flat File Versions IV and VI: (Note: These are for Sister Agencies only.)