Ohio Utilization Review
of Inpatient Psychiatric Care

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

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