PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form ODM01718
for the current year.
Form ODM01718 Notice of Denial of Assigned Provider or Pharmacy in the Coordinated Services Program (CSP) - Ohio
What Is Form ODM01718?
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 Form ODM01718?A: Form ODM01718 is the Notice of Denial of Assigned Provider or Pharmacy in the Coordinated Services Program (CSP) in Ohio.
Q: What does this form indicate?A: This form indicates that a provider or pharmacy has been denied in the Coordinated Services Program (CSP) in Ohio.
Q: What is the Coordinated Services Program (CSP)?A: The Coordinated Services Program (CSP) is a program in Ohio that provides coordinated and integrated health care services.
Q: Who uses this form?A: This form is used by providers and pharmacies who have been denied in the Coordinated Services Program (CSP) in Ohio.
Q: What is the purpose of this form?A: The purpose of this form is to notify providers and pharmacies of their denial in the Coordinated Services Program (CSP) in Ohio.
Form Details:
- Released on June 1, 2018;
- The latest edition provided by the Ohio Department of Medicaid;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form ODM01718 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.
