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(s) you are submitting now is(are) expected to pay on Thursday, September 11, 2014. REMINDER:YOUR PAY WILL BE DELAYED A DAY THIS WEEK DUE TO MONDAY(9/1) BEING LABOR DAY!!!
Patient/Consumer first name:
Provider # (7-digit No punctuation):
Confirmation Email Address (optional):
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