If you are a provider and wish to make a referral to the MLPC:

Fax a referral form to:

(419) 259-2880

Call ABLE and ask for an MLPC attorney:

(419) 255-0814

Physician Guide to Navigating the Medicaid-Managed Care System
for Medicaid-eligible Pediatric Patients

Advocacy Guide

Physician Strategies to Increase Patient Access to Healthcare
  • Write detailed prescription/coverage recommendation describing the child's condition and need for the service.
  • Explain any alternatives that have been tried and/or rejected and why they failed or will fail to address the underlying condition.
  • Explain how the services will correct or ameliorate the child’s physical or mental condition.
  • Be prepared to request a peer-to-peer review and argue for coverage.
  • You may need to request review by someone with a specific specialty background.
  • Be prepared to argue why the particular services are medically necessary.
  • Be prepared to file an appeal or advise the patient/parent to file.
  • Appeals can be filed directly with the Managed Care plan and/or or with the Department of Job and Family Services (file within 15 days to maintain coverage, 90 day appeal deadline).
  • If the appeal filed with Managed Care plan is denied, another appeal can be filed with the Department of Job and Family Services (90 day deadline).
  • For urgently needed care, make sure to request an expedited appeal.
  • Refer the family for legal assistance with appeal and provide family with documentation in support of the necessity of the service.
Related Links

National Center for Medical-Legal Partnership

The National Center for Medical-Legal Partnership supports the expansion, advancement, and integration of MLP by providing technical assistance to programs across the U.S. and Canada, facilitating the national MLP Network, promoting leadership in law and medicine, and coordinating national research and policy activities related to preventive law, health disparities, and the social determinants of health.

medical-legalpartnership.org

SSA

The Social Security Administration delivers services through a nationwide network of over 1,400 offices that include regional offices, field offices, card centers, teleservice centers, processing centers, hearing offices, the Appeals Council, and State and territorial partners, the Disability Determination Services. The SSA has a presence in U.S. embassies around the globe.

ssa.gov

Pathway Toledo

pathwaytoledo.org

Ohio Department of Job and Family Services

jfs.ohio.gov