Member eligibility and pharmacy overview
Actual member benefits and eligibility are determined in accordance with the requirements set forth by the state. Providers may submit claims, eligibility inquiries, claim status inquiries, and associated attachments using electronic data interchange (EDI) by being a trading partner (TP) authorized by Ohio Department of Medicaid (ODM) or by contracting with an ODM authorized TP.
Pharmacy information
Pharmacy benefits for enrolled members are managed through the ODM. Visit the Pharmacy information page for details surrounding the single pharmacy benefit manager, clinical criteria for medical injectables, and access to pharmacy resources.
Provider tools & resources
- Log in to Availity Essentials
- Launch Provider Learning Hub Now
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Provider Search Tool
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)