Once services have been provided, certified DODD providers can bill through eMBS for services that have been authorized for payment in the Payment Authorization for Waiver Services, or PAWS system.
DODD has a dedicated page for all things related to Waiver Billing.
REMEMBER: The Billing Rate for every Waiver Service can be found in that service’s appendix on the Rules page.
Guide for Submitting Claims for Waiver Services
Reporting Patient Liability
Patient Liability, or PL, is defined in Ohio Administrative Code 5160:1-6-07.1 as a person's "share of cost when the individual is not living in a medical institution." This is the only time a person with disabilities or the person's guardian must pay the provider directly for a portion of the cost of waiver services each month. Most people enrolled in waivers do not owe patient liability payments.
The provider collects patient liability payments from the person or their guardian; it is not paid to DODD, nor to the Ohio Department of Medicaid (ODM).
The provider reports patient liability amounts to DODD through the submission of waiver claims.
DODD provides guidance and training here.
Billing Support:
Resolving billing issues is not a one-size fits all approach.
Billing errors and denials will generate codes. The User Guides in eMBS contains resources to help determine what the issue is before contacting the assigned SSA who authorized the services which you are attempting to bill for.
Remember to send the SSA a screenshot/picture of the error code or error report.
DODD Billing Support → 1-800-617-6733 Option #3 for Billing
Stark DD Provider Compliance & Support began a new in-person support on 1/16/24 called
Billing Office Hours.