855 West Fifth Ave. Columbus, OH 43212 Phone: (614)294-6078 Fax: (614)294-6315 Medicaid Independent / Non-Agency Billing Form. Medicaid Agency Billing Form. Medicaid Ambulette Billing Form. Medicaid Adult Daycare Billing Form. Medicaid Homecare Attendant Billing Form. Caresource Billing Form. Molina Billing Form. Make a payment online. Prices and Submission Summary. Important Phone Numbers. FAQ Driving Directions.