Format: PDF
Audience: Providers
How to use: Specialty Drugs that process under the medical benefit will require prior authorization if included on this list. Drug list is subject to change. Follow the instructions in this document for submitting prior authorization forms.
Form number: N/A
Updated: 12/23
Format: Fillable form
Audience: Providers
How to use: Complete this form and submit to Archimedes (address and fax form is included on the form). Only the prescriber may complete this form. This form is for prospective, concurrent, and retrospective reviews. Please include applicable chart notes, laboratory results, and radiology findings. Incomplete forms will be returned for additional information.
Form number: V.OHY2022PA.5
Updated: 12/23
Format: Brochure
Audience: Providers
How to use: Providers can refer to this tutorial guide to learn about the capabilities of OhioHealthy’s portal and how to navigate it.
Form number: LH-2113-OHy
Updated: 12/23
Format: Brochure
Audience: Providers
How to use: Providers can refer to this tutorial guide to learn how to create an account and register on OhioHealthy’s portal.
Form number: LH-3018-OHy
Updated: 12/23