Please follow the Enrollment Instructions below to become an electronic submitter for Ohio Medicaid.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the ODJFS office prior to initiation of electronic claims submission or inquiry.

1. Medicaid Trading Partner Form (This is an ONLINE form)
2. Trading Partner Agreement (Please fill out 2 of these in Blue ink)
3. ODJFS Designation of an 835

If the above links to not work properly, please go directly to the OH Medicaid website here:
http://jfs.ohio.gov

If you have any questions regarding any of the documents in this package, please phone the ODJFS EDI Technology Support Center at 1-800-686-1516 or 844-324-7089.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Trading Partner Profile Form

To be completed by providers who will be submitting directly to ODJFS or Billing Services submitting to ODJFS for providers.

Trading Partner Company Information

Please enter your Provider/Business name and Tax ID
New applicants may leave the Trading Partner Number field blank

Trading Partner Technical Contact Information

Please enter the information for the Contact Person(s) for your office

EDI Testing and Connectivity Information & Business Agreements

Please read these 2 sections

Certification and/or Validation Testing

Please skip this section

Standards

Please read this section

Transaction Sets Submitted to the Ohio Department of Job and Family Services

Please select the following:

• 837 Health Care Institutional for UB04 claims and/or

• 837 Health Care Professional for CMS 1500 claims

Transaction Sets to be Sent by the Ohio Department of Job and Family Services

Please select the following:

• 835 Health Care Claim/Payment Advice

• TA1 Transaction Acknowledgement

• 997/999 Functional Acknowledgement

Click Submit to send your form

ODJFS Trading Partner Agreement

To be completed by providers submitting directly to ODJFS or Billing Services submitting to ODJFS for providers. Remember that you are the Trading Partner

• Please enter your Provider/Business information on the first page and complete the last page of this form

  • NOTE: You need to print out 2 copies of this form and fill them both out in BLUE ink

ODJFS Designation of an 835

This form must be completed and submitted after your test transmission has been approved. To be completed by an ODJFS provider

Section 1:

• Enter your Provider Name and Demographic information

Section 2:

• Enter your NPI, Provider ID and Trading Partner ID

Section 3:

• Enter your Contact information

Section 4:

• Enter either your TIN or NPI

Section 5:

• Leave this section blank as you will not be using a Clearinghouse

Section 6

• Check the box for New Enrollment and enters today's date

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:

Trading Partner Agreement:

Ohio Department of Job and Family Services
Office of Contract and Acquisitions
Trading Partner Agreements
30 East Broad Street, 31st Floor
Columbus, OH 43215

Designation of an 835:

Ohio Department of Job and Family Services
MMIS-EDI-Support-TPMF Updates
4200 E. Fifth Ave. – 1st Floor, Section E01
Columbus, Ohio 43219-1851

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the ODJFS EDI Technology Support Center at 1-800-686-1516 or 1-844-324-7089.

Testing

Once you have received your Submitter ID and password from ODJFS, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission.

Please have 3 batches containing 250 test claims ready for testing. You may use previously billed claims. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.