Manuals, Forms and Resources

New Provider Enrollment Forms

Enrollments Must be Submitted with the Form Below:

Non-Contracted Providers

  • If you are not contracted with Buckeye Health Plan or the group/facility you are with does not hold a contract with us, please go to the Join Our Network page.

Provider Update and Change Forms

Facility Agency Update and Change Forms 

Medicaid/General Forms

Medicare Forms

MyCare Forms

*JFS 03199 rev 04/2011 Must be used as of July 1, 2012

***Both versions 2010 and 2012 can be used as content remains unchanged.

For pregnant patients, Buckeye Providers may use the NOP form above, or submit the PRAF 2.0 form by following the instructions below on ODM's site:

InterQual criteria are available for your review upon request.

Please click on the documents below for more information about new Medicaid Level of Care Rule Changes that became effective March 19, 2012.

Ohio Managed Care Plans

Consolidated Medicaid Plan Resource Guide (PDF)

Ambetter Manuals & Forms

For Ambetter information, please visit our Ambetter website.