06/12/2025

Ohio Department of Medicaid: Prior Authorization Requirements Update

Learn about the comprehensive support plan to help navigate these changes.

Beginning August 1, the Ohio Department of Medicaid (ODM) will deny claims submitted without an approved prior authorization under the Fee-For-Service (FFS) policy. This change is critical to ensure compliance with Ohio Medicaid’s updated requirements.

To help you prepare for this transition, ODM has developed a comprehensive support plan:

• Training Opportunities: Beginning June 25 through August 5, ODM, in partnership with Provider Network Management (PNM) and Fiscal Intermediary (FI), will offer 10 two-hour training sessions. These sessions are designed to walk through the updated prior authorization process. The Department strongly encourages all providers to attend at least one session.  
• Warning Period: Starting July 1, claims submitted without the required prior authorization will receive a detailed warning edit notice in the remittance advice. Please utilize this opportunity to correct submissions before denials begin.
• Enforcement Begins: On August 1, claims without proper prior authorization will be denied.

Attending training will ensure you are fully prepared and confident in navigating the updated process.

Registration steps for enrolling through the ODM learning management system

Access the Absorb Learning Management System to register for the training. If you do not have an Absorb account, you must create one to access all training sessions, answer forms, and view various PNM module resources. For help, please follow their job aid  link and follow the steps to create your account and/or register for training. 

Please note that all claims remain subject to post-payment review. Since providers have already been instructed to submit prior authorizations, they anticipate minimal disruption.

Thank you for your continued commitment to providing quality care while maintaining compliance with Medicaid policies.

For more information

To learn more about the PNM module and Prior Authorization, visit the Provider Education and Training Resources page on the PNM portal. If you are experiencing technical issues accessing the PNM module or have specific questions, please contact the ODM Integrated Helpdesk at 800-686-1516 or IHD@medicaid.ohio.gov. The ODM Integrated Helpdesk is open 8:00 a.m.-4:30 p.m. Monday-Friday, Eastern time.