Filing a Complaint
Pharmacists filing complaints against Pharmacy Benefit Managers (PBMs), please click here to access the appropriate form.
A consumer or insured individual may file a complaint with the Ohio Department of Insurance's Office of Consumer Services.
A healthcare provider may submit a prompt pay complaint to the department by completing the Prompt Pay Complaint Form. A provider should follow all contract grievance and appeal procedures before filing the complaint.
The department has developed two online provider complaint processes; one for Prompt Pay and the other for Credentialing and Contract Complaints.
Credentialing and Contract Complaint
There is also an option for providers to file complaints pertaining to credentialing & contractual matters. This is a process established due to the recent enactment of legislation to address these issues (HB 125).
- INS0507 - Credentialing and Contract Complaint Form
- Online Credentialing and Contract Complaint Form
Responding to a Complaint
The department will forward provider complaints to the third-party payers for a response. The third-party payer will be directed to resolve the complaint directly with the provider. The third-party payer will notify the department of the resolution of the complaint.
- Third-party payer's Prompt Pay Response
- Third-party payer's Credentialing and Contract Complaint Response
- Frequently Asked Questions about Ohio's prompt payment laws and online complaint system