Ohio Department of Mental Health and Addiction Services
* Hospital Name:
Athens
Heartland
Northcoast
Summit
Toledo
Twin Valley
The hospital name is required.
* Patient First Name:
The patient first name is required.
The patient first name may not contain the semicolon (';') character.
The patient first name may not contain a credit card number.
* Patient Last Name:
The patient last name is required.
The patient last name may not contain the semicolon (';') character.
The patient last name may not contain a credit card number.
* Account Number:
The account number is required.
The account number may not contain the semicolon (';') character.
The account number may not contain a credit card number.
* Payment Amount:
The payment amount is required.
The payment amount is not valid.
The payment amount may not contain the semicolon (';') character.
The payment amount may not contain a credit card number.
Technical Support
If you need support for this online payment processing application, please send an email to
MHABilling@mha.ohio.gov
. You may also call our Toll-Free Bridge at 877-275-6364.