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Billing and Claims

Providers are reimbursed for services when

  • the services are identified on an approved individual service plan (ISP),
  • the service is recommended for payment through Payment Authorization for Waiver Services, or PAWS,
  • you have been certified by DODD to provide services,
  • you have provided the service, 
  • and you submit claims within 350 days of service.

Payment Authorization for Waiver Services (PAWS)

In order to be reimbursed for services, claims must match what has been approved for a person in the Payment Authorization for Waiver Services, or PAWS, system. Providers have read-only access to the PAWS system and should use it to verify a person’s waiver enrollment status and ensure that services are authorized before providing them. 

Service Documentation

Providers must maintain evidence they have provided services through service documentation. Documentation must be

  • stored in an accessible location,
  • provided, upon request, for review or an audit,
  • and stored for six years from date of payment or until the outcome of an audit, whichever is longer.

DODD does not require providers to use one specific form to document services, but there are requirements regarding what information must be documented. These requirements are located in rules specific to the service being provided. 

Client Eligibility

It is best practice for providers to verify the Medicaid eligibility of the people they serve. Eligibility information is available online through the Ohio Department of Medicaid MITS Portal. The information online also includes third-party liability, patient liability, and managed care status. A guide to accessing the portal is available through the Ohio Department of Medicaid.