- Authority & Guarantee Agreement Automated Clearing House Authority (ACH) - Healthcare Provider
- Blood Pressure Cuffs (Fillable Form)
- Breast Pump Order Form
- Clinical Programs Referral Form
- Concurrent Request Form
- EFT (Electronic Funds Transfer) and ERA (Electronic Remittance Advice) Enrollment Form
- MANNA Referral Form
- Physician Certification/Member Statement Abortion Forms (CHIP)
- Shift Care Authorization Form
The Obstetrical Needs Assessment Form (ONAF) is a standard perinatal assessment form that is accepted for all Medicaid recipients, including those participating in HealthChoices plans, the ACCESS Plus program, and the Fee for Service delivery system.
After the birth of a child, participating providers must complete an MA 112 form to notify the County Assistance Office (CAO) located in the mother’s county of residence of the birth to a mother who has valid Medical Assistance coverage. The MA 112 Form should be completed and submitted within 3 working days of the child’s birth.
To participate in our OB Provider P4P incentive program, you must use the ONAF to document appropriate obstetric care (prenatal, antenatal and postpartum). Please complete the ONAF online at obcare.optum.com within seven days of the initial prenatal visit, post-delivery, and upon completion of the postpartum visit.
If you need assistance or have questions about the ONAF, contact our Provider Helpline at 215-991-4350 or 1-888-991-9023. For more information about online ONAFs, reference the ONAF user guide.