Online Billing Form - step 1 of 4

Hello and welcome to our online billing form!

This page is for Ohio Medicaid. If the patient you are billing for has been switched to the MyCare Ohio program, if your patient has signed up with CareSource click here, or if your patient has signed up with United Health, Aetna, Molina, and others click here.

The Claim you are submitting now is expected to pay on Thursday, October 30, 2014.
Patient/Consumer first name:
Provider # (7-digit No punctuation):
Confirmation Email Address (optional):
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