MedicaidAdministrativeMedium impact
5160-2-12 - Appeals and reconsideration of departmental determinations regarding hospital inpatient and outpatient services. (New/Final File)
Ohio Medicaid·OH·Medical Policy
Effective date
Jun 12, 2022
We identified it
Jun 20, 2026
Summary
Ohio Medicaid has established new Rule 5160-2-12 governing the appeals and reconsideration process for departmental determinations regarding hospital inpatient and outpatient services. This creates a formal framework for healthcare providers to challenge Ohio Medicaid decisions on hospital service coverage and reimbursement.
Action Required
Review the new Ohio Medicaid appeals process outlined in Rule 5160-2-12 for hospital inpatient and outpatient services. Billing team should familiarize themselves with the formal reconsideration procedures and contact Tommi Potter at 614-752-3877 for specific guidance on appealing departmental determinations. Update internal procedures for handling Ohio Medicaid claim denials or coverage disputes.