Medicare AdvantageAdministrativeHigh impact
Mutual News November 2025 Bulletin
Medical Mutual of Ohio·OH·Mutual News Bulletin
Effective date
Dec 1, 2025
We identified it
Jun 20, 2026
Summary
Medical Mutual is implementing multiple major operational changes including mandatory electronic PAR submissions through Availity (Dec 1, 2025), faster Organization Determination timeframes for Medicare Advantage inpatient reviews (Jan 1, 2026), and a clearinghouse transition away from Change Healthcare/Optum (Dec 2, 2025). Several reimbursement policies are also being revised effective December 17, 2025.
Action Required
By December 1, 2025: All staff must transition to electronic PAR submissions through Availity portal - register for free account at medmutual.com/Provider and locate PAR forms under Resources tab. By December 2, 2025: Establish new clearinghouse relationship as Change Healthcare/Optum connection ends - update EDI routing for claims, eligibility, and remittance processing. By January 1, 2026: For Medicare Advantage inpatient cases, providers must complete peer-to-peer reviews within 24 hours (reduced from 14 days) or cases automatically proceed to appeal. Register for new Optum Payment Integrity Portal to streamline medical records submissions.