CommercialReimbursementHigh impact
[Ohio] Reimbursement policy update: After‑Hours, Emergency, and Miscellaneous E/M Services — Professional and Facility
Anthem BCBS·OH·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 8, 2026
Summary
Effective April 1, 2026, Anthem Ohio is expanding its After-Hours E/M Services reimbursement policy to include facility providers, but with a critical restriction: facility providers will NOT receive separate reimbursement for after-hours codes when billed on UB-04 forms (except for place of service 20 - urgent care facilities). This represents a change in reimbursement eligibility for facility-based services rendered during after-hours timeframes (5 p.m. to 8 a.m. weekdays, or anytime on weekends).
Action Required
By March 31, 2026: Billing team must review and update billing workflows to reflect that facility providers can NO LONGER bill separate after-hours codes on UB-04 forms (except POS 20). Implement system controls to prevent submission of after-hours charges for facility providers on institutional claims. Update revenue cycle staff and facility billing personnel on the new restrictions. Verify that urgent care facilities (POS 20) continue to have after-hours reimbursement eligibility. Professional providers remain eligible for after-hours reimbursement per existing policy. Failure to comply will result in claim denials for improperly billed after-hours facility services.