Medicaid Provider Contract Templates

Medicaid Provider Contract Templates

• Ancillary Provider Participation Agreement
• DentaQuest Agreement
• Facility Participation Agreement 
• FQHC - RHC Participation Agreement 
• Home and Community Based Services - Long Term Services and Supports - Provider Participation Agreement 
• Managed Care Entity - Group Provider Affiliations - Attachment A 
• Managed Care Entity - Services Provided - Attachment C
• March Vision Services Agreement
• Medicaid and CHIP Regulatory Requirements Appendix
  
• Medical Group Participation Agreement
• Ohio Regulatory Requirements Appendix
• Practitioner Participation Agreement 
  
• Provider Organization Participation Agreement - Opt-In
• Provider Organization Participation Agreement - SS
• Small Medical Group Participation Agreement
• Small Provider Group Agreement

Optum Behavioral Health Medicaid Provider Contract Templates

• Optum Behavioral Health Medicaid Addendum
• Optum Behavioral Health Medicaid Downstream Provider Regulatory Requirements Appendix 
• Optum Behavioral Health Ohio Group Agreement
• Optum Behavioral Health Regulatory Requirements Attachment
• Optum Behavioral Health Summary Disclosure

Optum Physical Health Medicaid Provider Contract Templates

• Optum PT ODM - Managed Care Entity - Group Provider Affiliations - Attachment A
• Optum PT ODM - Managed Care Entity - Services Provided - Attachment C
• Optum PT ODM - Provider Agreement
• Optum PT ODM - Regulatory Addendum
• Optum PT ODM - Regulatory Appendix