Materials, Forms and Helpful Links for Providers| OhioRISE – Aetna Better Health

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Materials, forms and links

Materials

Provider manual (7.2024) (PDF)

OhioRISE Mixed Services Protocol Introduction (PDF)

OhioRISE Provider Agreement Contract (PDF)

MSY Overview Process (PDF)

MSY Provider Orientation (PDF)

MSY Provider Agreement (PDF)

Multi System Youth Training Video

MSY Initial Application Signature Pages (PDF)

MSY Initial Application Form, Version 5.2 (PDF)

OhioRISE Example-MSY Initial Application Form (PDF)

MSY New Application Training Form (PDF)

J. Birch MSY Update and Final Application Example (PDF)

J. Birch Update Example Signature Pages (PDF)

J. Birch Update Example Signature Pages (PDF)

J. Jump MSY Update Add Shift Funds Example (PDF)

J. Jump Update Shifting Funds Example Signature Pages (PDF)

MSY Update and Application for Additional Shifting Funds 5.2 FORM (PDF)

MSY Update Section Reference Slides (PDF)

S. Shell MSY Update Additional Funds - Routine Example (PDF)

S. Shell MSY Update.Additional Funds Example - Signature Pages (PDF)

MSY Initial Application

MSY Update and Additional/Shifting Funds Form

If an MSY provider needs an invoicing template, please contact OhioRISEMSYInvoices@aetna.com

If a MSY provider needs any documents in Microsoft Word format, please contact SmithS50@aetna.com.

Forms

General Release of Information (PDF)

Non Par Authorization Request Form (PDF)

Partial Hospital Program (PHP) Authorization Form (PDF)

Helpful links

OH PRTF Program Manual v1.1 (PDF)

Provider network management module (ODM)

Ohio Medicaid Managed Care: OhioRISE

Ohio Department of Medicaid: Resources for providers

OhioRISE Care Management Entity (CME) Regions Map (PDF)

Portland State University: National Wraparound Initiative (NWI)

Ohio Administrative Code: Chapters 5160-26 and 5160-59

Attention Deficit Hyperactivity Disorder Medication (PDF)

Antidepressant Medication Management (PDF)

Metabolic Monitoring for Children and Adolescents on Antipsychotics (PDF)

Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (PDF)

Follow Up After Emergency Department Visit for Alcohol and Other Drug Dependence (PDF)

Follow Up After Hospitalization for Mental Illness (PDF)

Follow Up After Emergency Department Visit for Mental Illness (PDF)

Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (PDF)

Oral Evaluation, Dental Services (PDF)

Children and Adolescent Well-Care Visits (PDF)

Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents: BMI Percentile Documentation (PDF)

Member materials and forms

Find all the materials and forms a member might need — right in one place. 

Materials and forms