Dyserv, Inc.






1144 Goodale Blvd
Columbus, OH 43212
Phone: (614)294-6078
Fax: (614)294-6315


Medicaid:

Medicaid Independent / Non-Agency Billing Form

Medicaid Agency Billing Form

Medicaid Ambulette Billing Form

Medicaid Adult Daycare Billing Form

Medicaid Homecare Attendant Billing Form

Medicaid Home Delivered Meals Billing Form
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Caresource:

CareSource Billing Form (Old 2008 rates)

CareSource MyCareOhio Independent Billing Form (2016 rates)

CareSource MyCareOhio Agency Billing Form (2016 rates)

CareSource Ambulette Billing Form
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Molina, Buckeye, Paramount, UHC, Aetna & VA:

Independent / Non-Agency Billing Form

Agency Billing Form
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DODD:

DODD Billing Form



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Prices and Submission Summary
Important Phone Numbers
FAQ