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Enrollment Provider Checklists

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).. 16 17 Provider Enrollment Change of Operator (CHOP) Checklist: Nursing Facilities (NFs) Intermediate Care Facilities for the Mentally Retarded (ICFs-MR).

A copy of your certification as a State Tested Nurse’s Aide (STNA) (if applicable) Copy of First Aid card (for Personal Care Aides and Home Care Attendants) Confirmation from Consumer – JFS 06724 (for Personal Care Aide and Home Care Attendant) Documentation of Training if not STNA JFS 06722 (for Personal Care Aide and Home Care Attendant)

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