Form ODM10273 Voluntary Termination of Ohio Medicaid Provider Agreement - Ohio

What Is Form ODM10273?

This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is ODM10273?A: ODM10273 is a document for the voluntary termination of an Ohio Medicaid Provider Agreement in Ohio.

Q: What is the purpose of ODM10273?A: The purpose of ODM10273 is to provide a form for healthcare providers in Ohio to voluntarily terminate their Medicaid Provider Agreement.

Q: Who can use ODM10273?A: Healthcare providers in Ohio who wish to voluntarily terminate their Medicaid Provider Agreement can use ODM10273.

Q: Is ODM10273 mandatory?A: No, ODM10273 is a voluntary form, and healthcare providers are not obligated to use it.

Q: What information is needed to complete ODM10273?A: To complete ODM10273, healthcare providers need to provide their name, provider ID, termination effective date, reason for termination, and a signature.

Q: What happens after submitting ODM10273?A: After submitting ODM10273, the Ohio Department of Medicaid will process the termination request and update the provider's status accordingly.

Q: Are there any consequences to terminating a Medicaid Provider Agreement?A: Terminating a Medicaid Provider Agreement may affect the provider's ability to participate in the Medicaid program and receive reimbursement for services.

Q: Can a provider reapply for a Medicaid Provider Agreement after termination?A: Yes, a provider can reapply for a Medicaid Provider Agreement after termination, but the Ohio Department of Medicaid will review the application and make a determination based on their policies and guidelines.