Ohio Administrative Code Search

...amples include, but are not limited to, provider selection or referral, preadmission certification, length of stay determination and second surgical opinions. (3) "Day" means calendar day. However, when the last day of a time limit stated in this rule falls on a Saturday, Sunday or state or federal holiday, the time limit is extended to the next immediate following day that is not a Saturday, Sun...

...amples include, but are not limited to, provider selection or referral, preadmission certification, length of stay determination and second surgical opinions. (3) "Day" means calendar day. However, when the last day of a time limit stated in this rule falls on a Saturday, Sunday or state or federal holiday, the time limit is extended to the next immediate following day that is not a Saturday, Sun...

...ations or restrictions on access to providers/facilities to enrollees and to potential enrollees prior to enrollment in a particular health plan. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code, general rule making authority; and section 3901.21 of the Revised Code, the unfair and deceptive acts statute. (C...

...ations or restrictions on access to providers/facilities to enrollees and to potential enrollees prior to enrollment in a particular health plan. (B) Authority This rule is promulgated pursuant to the authority vested in the superintendent under section 3901.041 of the Revised Code, general rule making authority; and section 3901.21 of the Revised Code, the unfair and deceptive acts statute. (C...

... are provided by an out-of- network provider when either of the following conditions applies: (a) The covered person did not have the ability to request such services from an in-network provider. Clinical laboratory services provided by an out-of-network provider, but that are ordered by an in-network provider, shall be considered to have met the condition prescribed in paragraph (E)(7)(a) of ...

...tial licensure as a viatical settlement provider in this state or renewal of a previously-issued license. This rule also provides form filing requirements and fees for licenses, renewals, and form approvals. (B) Authority This rule is promulgated under the authority granted the superintendent of insurance pursuant to sections 3901.011, 3901.041, 3901.19 to 3901.26, 3916.05, and 3916.20 of the Revised Code. (C) Ap...

...rds and procedures and fees for VSE providers, VSE courses and licensed viatical settlement brokers pursuant to Chapter 3916. of the Revised Code. (B) Authority This rule is issued pursuant to the authority vested in the superintendent under sections 3901.011, 3901.041, 3901.19 to 3901.26, 3916.03, and 3916.20 of the Revised Code. (C) Application and scope This rule applies to all persons applying...

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...nanced projects, the issuer of bonds or provider of other similar financing shall arrange for the appointment of a prevailing wage coordinator, except where the identity of said coordinator is provided by law. (D) In the event that the public authority does not appoint a prevailing wage coordinator, commerce may appoint a coordinator. The public authority shall reimburse commerce for the cost of such prevailing wage...

...ed projects, the issuer of bonds or provider of other similar financing shall arrange for the appointment of a prevailing wage coordinator, except where the identity of said coordinator is provided by law. (D) In the event that the public authority does not appoint a prevailing wage coordinator, commerce may appoint a coordinator. The public authority shall reimburse commerce for the cost of ...

...rom the beginning of the unit; (d) The provider utilizes procedures that provide reasonable assurance of participant identity and that the participant receiving the continuing education credit for completing the course actually performed all of the work required to complete the course; and (e) The provider utilizes a clock or timer on each screen that accurately records the course completion ...

...the beginning of the unit; (c) The provider utilizes procedures that provide reasonable assurance of participant identity and that the participant receiving the continuing education credit for completing the course actually performed all of the work required to complete the course; and (d) The provider utilizes a clock or timer on each screen that accurately records the course completion time to...

...eted by the employee, employer, medical provider, or other interested party. If someone other than the employee submits a FROI-1 or equivalent, the bureau may contact the employee to attempt to verify that the employee wishes to pursue the application. To accept or deny the validity of the claim, the employer may complete and sign the form at the designated point or may use a separate writing, tel...

...eted by the employee, employer, medical provider, or other interested party. If someone other than the employee submits a FROI-1 or equivalent, the bureau may contact the employee to attempt to verify that the employee wishes to pursue the application. To accept or deny the validity of the claim, the employer may complete and sign the form at the designated point or may use a separate writing, tel...

...eted by the employee, employer, medical provider, or other interested party. If someone other than the employee submits a FROI or equivalent, the bureau may contact the employee to attempt to verify that the employee wishes to pursue the application. To accept or deny the validity of the claim, the employer may complete and sign the form at the designated point or may use a separate writing, telep...

...ut is not required to, negotiate with a provider to accept fee bills from the provider for a time period other than as set forth in paragraph (A) of this rule. (C) Paragraph (A) of this rule shall not apply to the following: (1) Requests made by the centers for medicare and medicaid services in the United States department of health and human services for reimbursement of conditional payments made pursuant to secti...

...s not required to, negotiate with a provider to accept fee bills from the provider for a time period other than as set forth in paragraph (A) of this rule. (C) Paragraph (A) of this rule shall not apply to the following: (1) Requests made by the centers for medicare and medicaid services in the United States department of health and human services for reimbursement of conditional payments ma...

...s not required to, negotiate with a provider to accept fee bills from the provider for a time period other than as set forth in paragraph (A) of this rule. (C) Paragraph (A) of this rule does not apply to the following: (1) Requests made by the centers for medicare and medicaid services in the United States department of health and human services for reimbursement of conditional payments mad...

...he payment from the claimant or the provider.

...he payment from the claimant or the provider.

...lowed condition. (B) "Bureau certified provider" means: A provider who is approved by the bureau for participation in the health partnership program (HPP) pursuant to this chapter of Administrative Code. (C) "Certification" or "recertification" means: A process by which the bureau approves a provider or managed care organization (MCO) for participation in the HPP. (D) "Credentialing" or "...

...e bureau is authorized to certify a provider who wishes to participate in the HPP. The bureau is authorized to recertify a provider at least every one to three years. The bureau may, but is not required to, recertify providers on a staggered basis, in order of the provider's initial certification date or such other criteria as the bureau determines appropriate. (B) A provider shall be certified o...

...) The bureau is authorized to certify a provider who wishes to participate in the HPP. The bureau is authorized to recertify providers as determined by the bureau. The bureau may, but is not required to, recertify providers on a staggered basis, in order of the provider's initial certification date or such other criteria as the bureau determines appropriate. (B) A provider shall be certified or recertified by the bu...

...au shall establish minimum criteria for provider certification. Providers must meet all licensing, certification, or accreditation requirements necessary to provide services in Ohio. A provider licensed, certified or accredited pursuant to the equivalent law of another state shall qualify as a provider under this rule in that state. However, a provider will be ineligible to participate in the heal...