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Medical Mutual of OhioAll Plans · Administrative · Mutual News NewsletterMedium impact

Mutual News March 2025 Newsletter

Effective date
Sep 1, 2025
Identified
Jun 20, 2026

Summary

Medical Mutual requires all medical claims to be submitted electronically. Beginning September 1, 2025, it no longer accepts medical claim submissions via paper or email. Four reimbursement policies were implemented effective May 1, 2025: Emergency Department Fracture Care (RP-202506), Services and Modifiers Not Reimbursable to Health Care Professionals (RP-202507), Preventive Medicine, Screening, and Evaluation and Management Services (RP-202508), and Initial Preventive Physical Examination, Annual Wellness Visit, Preventive Medicine, and Evaluation and Management Services for Medicare Advantage (RP-202509). Regular provider notices are available only on the provider website after June 30, 2025.

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What to do

Action · 7 steps
01Already effective September 1, 2025: Billing team must submit all medical claims to Medical Mutual electronically, through a clearinghouse or through the Availity provider portal, because paper and email medical claims are no longer accepted.
02Already effective May 1, 2025: Review the four new reimbursement policies at MedMutual.com/Provider under Policies and Standards > Reimbursement Policies.
03Billing team: when a problem-oriented visit (99202-99215) is billed on the same day as an annual wellness visit, add modifier 25 to the problem-oriented visit code and document the additional work; do not add modifier 25 to the annual wellness visit or other wellness codes, including vaccines.
04Tell patients at the time of service that an added service is being billed.
05Medicare Advantage wellness visits: the initial preventive physical exam (G0402) must be provided in person, and the health risk assessment is incomplete if any required element is missing.
06Depression screening (G0444), advance care planning (99497-99498) and social determinants of health risk assessment (G0136) are time-based services and must be documented accordingly.
07Risk adjustment record requests: fax medical records requested by Scanning Sherpas to (385) 503-9153, do not send them directly to Medical Mutual, and call the Scanning Sherpas Provider Support line at 1-801-997-9108 with questions.

Codes mentioned

G0402G0438G0439G0444G01369949799498

Original notice

Mutual News March 2025 Newsletter
medmutual.com · Always check the source before changing claims.
View original ↗

Related changes

See all Medical Mutual of Ohio changes →
Guidelines for Coding a Wellness Visit and Sick Visit Occurring on the Same DayMediumNo effective date · CodingMutual News Q1 2021 NewsletterMediumEffective Jun 1, 2021 · Mutual News NewsletterEffective Sept. 1, 2025, Medical Mutual is Moving to All Electronic Medical Claims ProcessingHighEffective Sep 1, 2025 · In the NewsMutual News June 2025 NewsletterMediumEffective Nov 1, 2025 · Mutual News NewsletterBrowse every Medical Mutual of Ohio change in the policy list

Related policy hubs

Medical Mutual of Ohio policiesCode G0402Code G0438Code G0439Code G0444Code G0136Code 99497Code 99498

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