Process to Resolve Medicaid Disputes Established by State – AMCNO Resources Also Available for Insurance Dispute Resolution 

The Ohio Department of Job and Family Services has established a process to assist healthcare providers in pursuing unresolved concerns with Medicaid managed care plans. This process is to be used after exhausting the existing processes. If after utilizing the processes, providers can complete a complaint form at http://jfs.ohio.gov/ohp/bmhc/pro-man-care.stm.

Once a provider has completed and submitted the form, ODJFS staff will work with the provider and the Medicaid managed care provider (MCP) to address the issues and ensure that the MCO is in compliance with their contract. MCPs have 15 days to respond to ODJFS. The only exception is if the complaint is related to a Medicaid consumer's access to care. Those issues require a two working day response time. 

AMCNO members should remember that the AMCNO staff and physician leadership have developed working relationships with all of the third party payors in our area and we meet or conference with them on a regular basis. The AMCNO will assist our members and their staff if they have complaints or problems with insurance companies. Our insurance complaint form is posted on our website at www.amcnoma.org or you may call the AMCNO at 216-520-1000 for more information.