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Ohio Utilization Review
of Inpatient Psychiatric Care


Picture of a Baby's hand touching care givers hand.Health Care Excel (HCE) is a contractor to the Ohio Department of Mental Health (ODMH), providing a comprehensive monitoring program staffed by professionals who have detailed knowledge and understanding of the federal and state guidelines.

HCE is responsible for the contractual oversight of the Utilization Review of Inpatient Psychiatric (URIP) Care for the ODMH, performing on-site post-payment reviews (OSPPR) for medical necessity. The three components of the program include Preadmission Certification, Post-Payment Reviews, and Provider Education.
 

HCE's objective is to monitor the following.

  • Clinical appropriateness of inpatient psychiatric care
  • Unnecessary or inappropriate use of Medicaid services and excess payment
  • Quality of inpatient care
  •  Adequacy with which facilities providing psychiatric care meet applicable provisions of state and federal guidelines governing the care

Monitoring is carried out through the following actions.

  • Development of medical necessity criteria
  • Preadmission certification
  • Selection of cases for post-payment review
  • Provider appeals
  • Recipient hearings
  • Provider training
  • Management reporting systems
  • Intensive case or facility review
The utilization review processes are structured to monitor the following elements.
  • Medical necessity for inpatient care
  • Premature discharge
  • Appropriateness of readmission
  • Children's admissions
  • Validation of the Diagnosis Related Group (DRG) assignment
  • Appropriateness of treatment and discharge planning
  • Compliance with the pre-certification process
  • Lengths of stay

Ohio URIP Newsletter

Ohio URIP Application


Important Contact Information

Printable PDF Version
 

Health Care Excel Facsimile Number
Pre-admission certification requests
(800) 281-9386

Ohio Medicaid Provider Network Management
(614) 752-9551

Pre-admission Certification or First-level Clinical Appeals
Ohio URIP Review Operations
Health Care Excel, Incorporated
2629 Waterfront Parkway East Drive, Suite 200
Indianapolis, IN 46214
(800) 580-1937

Claims Address
Ohio Department of Job and Family Services
Bureau of Claims Services
Claims Adjustment Section
P.O. Box 149
Columbus, OH 43266-0149
(614) 466-5080

Ohio Medicaid Interactive Voice Response System
(800) 686-1516

General URIP or Post-payment Review Questions
Ann Carter, RN
Contract Director, Ohio URIP Program
Health Care Excel, Incorporated
30 East Broad Street, 7th floor
Columbus, OH 43215
(614) 387-3088
askurip@hce.org

Technical or Second-level Clinical Appeals
Terry R. Jones
Manager of Medicaid Program Compliance
Ohio Department of Mental Health
Office of Medicaid
30 East Broad Street, 7th floor
Columbus, OH 43215
(614) 466-9982

  


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