Enrollment Provider Checklists

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Ohio Medicaid Web Portal Enrolling Provider Checklists by Request Type Ohio Department of Job and Family Services odjfs Medicaid Web Portal Provider Enrollment Checklists 2 TABLE OF CONTENTS General Instructions ........................................ ........................................ ...................................3 Provider Enrollment Application Checklist: Individual 6 Provider Enrollment Application Checklist: Practitioner Group ........................................ . 7 Provider Enrollment Application Checklist: 8 9 Provider Enrollment Application Checklist: 10 11 Provider Enrollment Application Checklist: Managed Care 12 13 Provider Enrollment Application Checklist: Nursing Facility (NF).................................. 14 15 Provider Enrollment Application Checklist: Intermediate Care Facilities for the Mentally Retarded (ICFs-MR).

ODJFS Medicaid Web Portal Provider Enrollment Checklists 10 Print a copy of the application package for your records by clicking “Print Application” on the online “Confirmation Receipt” panel displayed at the end of the enrollment process. If you need assistance completing the application, please call the Provider Enrollment Unit

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