OH ODM 07136 2014 free printable template
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Name of provider NPI # Medicaid Legacy # Ohio Department of Medicaid CERTIFICATE OF MEDICAL NECESSITY/PRESCRIPTION EXTERNAL INFUSION PUMP INITIAL Prescription Date: RECERTIFICATION PA#: REVISED PA#:
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Who needs OH ODM 07136?
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Individuals applying for services or benefits through the Ohio Department of Medicaid may need to fill out the OH ODM 07136 form.
02
Caregivers or representatives submitting on behalf of a Medicaid recipient may also require this form.
03
Healthcare providers involved in the enrollment or verification process for Medicaid services may need to utilize the form.
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What is OH ODM 07136?
OH ODM 07136 is a state form used in Ohio for reporting specific information related to Medicaid and healthcare services.
Who is required to file OH ODM 07136?
Providers of Medicaid services and other related stakeholders who are involved in the administration of healthcare services in Ohio are required to file OH ODM 07136.
How to fill out OH ODM 07136?
To fill out OH ODM 07136, you should gather the required information as outlined in the instructions, complete each section accurately, and submit it according to the guidelines provided by the Ohio Department of Medicaid.
What is the purpose of OH ODM 07136?
The purpose of OH ODM 07136 is to collect necessary data for compliance, reimbursement, and monitoring of Medicaid services within the state of Ohio.
What information must be reported on OH ODM 07136?
The information that must be reported on OH ODM 07136 includes provider identification, service details, patient information, and any relevant financial data as required by the Ohio Department of Medicaid.
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