Pregnancy & Prenatal Information

Perinatal Risk Assessment Form (PRAF)

A complete PRAF helps Moms receive the best support for a healthy pregnancy

Benefits of submitting a PRAF

The electronic PRAF 2.0 has multiple benefits with one, simple submission:

• Automatically notifies the Ohio Department of Job and Family Services County Office, Managed Care Plan, the Ohio Department of Medicaid and WIC of the pregnancy, engaging resources and support.
• Maintains a pregnant woman’s Medicaid eligibility without disruption in coverage-equating to prompt provider payment for services throughout mom’s pregnancy and the first twelve months postpartum.

Submitting the PRAF 2.0 using Nurture Ohio is Easy!

1. The complete Provider User Guide can be found at PRAF Provider User Guide 2026.
   This resource includes step-by-step instructions with helpful screen shots covering registration through submission
   .
2. A Comprehensive Billing Guide may be found at  
   Perinatal Risk Assessment Form (PRAF) FFS Billing Guide - ODM June 1, 2026
   Recently developed by the Ohio Department of Medicaid, this tool provides detailed guidance for billing for the PRAF.
3. System Questions?  Email: MomsAndBabies@medicaid.ohio.gov
4. Support at Buckeye Health Plan
   Provider Services at: 866.296.8731
   or
   Mindy Ridgeway at:  Melinda.ridgeway@centene.com
   
   

PRAF FAQ  2026
What is the Perinatal Risk Assessment Form (PRAF)?
Obstetrical Provider should Submit a Perinatal Risk Assessment Form (PRAF) on behalf of all of their patients covered by Ohio Medicaid.
The Perinatal Risk Assessment Form (PRAF) is intended for submission at the patient’s first prenatal visit. The PRAF replaced the ODM 03535 form.  It’s purpose if to provide early pregnancy notification and engagement between the member, provider and MCO with the goal of improving birth outcomes for Ohio Medicaid enrollees and those covered by the seven Managed Care Organizations. 

The PRAF should be submitted during the first prenatal appointment, whenever there is a change in the patient’s social or medical risk factors or needs and at the postpartum visit.

The PRAF is submitted electronically through the NurtureOhio website.

What is the role of the PRAF?
The PRAF provides an assessment of risk and supports access to needed services directly impacts pregnancy related outcomes including maternal and infant mortality.  As tools for early notification of pregnancy, the PRAF acts as catalysts to partnership and collaboration between Providers and MCO to best address each individual patient’s needs and risks.

For Members:

• Improves maternal and infant outcomes.
• Maintains Medicaid eligibility without disruption in coverage through the immediate post-partum period of 12 months post-delivery.
• Allows for the timely connection to added resources and care coordination.

For Providers:

• Integrates with the Ohio Department of Job and Family Services County Office, Managed Care Plan, WIC, ODH, DCY and Visiting Nurse Services.
• Informs the MCO and other entities of identified needs including physical, behavioral health and SDoH allowing care coordination and services.
• Maintains a pregnant woman’s Medicaid eligibility without disruption in coverage-equating to prompt provider payment for services throughout mom’s perinatal period.

How is a PRAF submitted?
PRAFs are submitted via the Nurture Ohio site 
Nurture Ohio is a web-based system that stores and shares information about pregnancy and related needs. This information is collected using the electronic Perinatal Risk Assessment Form (PRAF 2.0).

All provider users of the NurtureOhio site must be associated with an enrolled Medicaid provider. If a practice site is not a Medicaid provider, they will need to complete the enrollment process. Enrollment applications must be submitted using Ohio Medicaid's Provider Network Management (PNM) module. Anyone accessing the Provider Network Management (PNM) module will need an OH|ID to log in. Provider users will need to use their OH|ID to access the NurtureOhio system.

Support for registration and submission can be found here, with a complete user guide found here: PRAF Provider User Guide 2026

Is there reimbursement for the PRAF?
Yes!  There is reimbursement PRAF submissions.
The Ohio Department of Medicaid (ODM) published the Medicaid payment rule for the Perinatal Risk Assessment Form.  This rule became effective on January 1, 2026. This grid provides coding and reimbursement guidelines.   MAL No 687 Payment for FFS Claims PRAF. 

A Comprehensive Billing Guide for PRAF may be found at:
Perinatal Risk Assessment Form (PRAF) FFS Billing Guide - ODM June 1, 2026

Is PRAF approved for Telehealth?
Yes!  PRAF is included as a telehealth service effective January 1, 2026
The Ohio Department of Medicaid (ODM) has approved PRAF (HCPCS Code H1000) as a telehealth service effective on January 1, 2026.   Tool for Prenatal Members with Barriers

• Standalone Service (may be billed independently)
• Reported with the GT modifier when performed as a telehealth service.   

A complete Guide to telehealth billing, including PRAF can be found at the following link:  ODM Telehealth Guide 2026

How many PRAFs may be submitted during each pregnancy?

Six (6) Perinatal Risk Assessment Forms may be reimbursed during a pregnancy. OAC 5160-21-04 Pregnancy Related Services

• Up to six (6) PRAFs may be submitted for each pregnancy.
• Initial PRAF
• Postpartum PRAF
• Updated PRAF with a change in Medical or SDOH Condition

Examples*

• Specialist Referral
  MFM, Perinatology, Endocrinology, Pediatric Specialists
• Health condition that increases risk of preterm birth or poor birth outcome.
  Preeclampsia, Gestational Diabetes, Conditions of the Cervix, Conditions of the Fetus
• Behavioral Health Issues or Substance Use
• SDOH Needs
• Food or Housing Insecurity, Transportation, Communication Barriers  

* Examples for discussion purpose only.  List is not all inclusive.

The Ohio PRAF (Pregnancy Risk Assessment Form) provides vital information to Ohio’s managed care plans. It lets us use our resources in the best way to help pregnant Medicaid recipients.

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