PDF
Word
Form ODM06306 Designation of an 835 or 834-820 Trading Partner - Ohio
What Is Form ODM06306?
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. Check the official instructions before completing and submitting the form.
FAQ
Q: What is the purpose of Form ODM06306?A: The purpose of Form ODM06306 is to designate a trading partner for electronic transactions related to the Ohio Department of Medicaid (ODM) 835 or 834-820 formats.
Q: What are the ODM 835 and 834-820 formats?A: The ODM 835 and 834-820 formats are specific electronic transaction formats used by the Ohio Department of Medicaid for healthcare claims and enrollment data, respectively.
Q: Who should use Form ODM06306?A: Any entity or organization that wants to become a trading partner with the Ohio Department of Medicaid for electronic transactions using the 835 or 834-820 formats should use Form ODM06306.
Q: What information is required on Form ODM06306?A: Form ODM06306 requires information such as the trading partner's name, contact information, business type, and the type of electronic transactions they plan to exchange with the Ohio Department of Medicaid.
Q: Are there any fees associated with submitting Form ODM06306?A: No, there are no fees associated with submitting Form ODM06306 to designate a trading partner for the ODM 835 or 834-820 formats.
Form Details:
- Released on September 1, 2021;
- 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 ODM06306 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.
