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ACTION: RevisedDATE: 05/18/2017 2:13 Rule Summary and Fiscal Analysis (Part A) Ohio Department of Medicaid Agency NameTommi Potter DivisionContact50 Town St 4th floor Columbus OH 43218270961475238776149951301Agency

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What is 5160-8-05 new?

5160-8-05 new is a form used for reporting specific information related to health care services provided under Medicaid in Ohio.

Who is required to file 5160-8-05 new?

Providers of Medicaid services in Ohio are required to file the 5160-8-05 new form.

How to fill out 5160-8-05 new?

To fill out the 5160-8-05 new form, you must provide accurate information about services rendered, provider details, and patient data as specified in the instructions included with the form.

What is the purpose of 5160-8-05 new?

The purpose of 5160-8-05 new is to collect data for reimbursement and auditing purposes for health care services provided to Medicaid beneficiaries.

What information must be reported on 5160-8-05 new?

The form must report information such as service dates, type of services provided, provider identification, patient details, and any relevant billing information.

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