Medicare AdvantageAdministrativeMedium impact
Mutual News February 2025 Bulletin
Medical Mutual of Ohio·OH·Mutual News Bulletin
Effective date
Mar 1, 2025
We identified it
Jun 20, 2026
Summary
Medical Mutual is updating multiple provider manual sections and reimbursement policies with staggered effective dates. Changes include inpatient review guidelines (effective June 2, 2025), prior authorization general guidelines (effective March 3, 2025), and hospital readmission policies for both non-Medicare Advantage and Medicare Advantage plans (effective March 1, 2025).
Action Required
By March 1, 2025: Review updated Hospital Readmissions reimbursement policies RP-201902 (Non-Medicare Advantage) and RP-202408 (Medicare Advantage) at MedMutual.com under Provider menu > Policies and Standards > Reimbursement Policies. By March 3, 2025: Review revised Prior Authorization General Guidelines on page 38 of Provider Manual Section 3. By June 2, 2025: Review updated Inpatient Review Guidelines on page 40 of Provider Manual Section 3. All updates available at MedMutual.com/Provider > Provider Manual.