CommercialPrior AuthMedium impact
Site of Care Management Change
Medical Mutual of Ohio·Pediatrics·In the News
Effective date
Jan 1, 2019
We identified it
Jun 20, 2026
Summary
Medical Mutual lowered the pediatric age exemption for Site of Care Management prior authorization from 21 years to 17 years, effective January 1, 2019. Children 17 and under are now excluded from prior auth requirements, while patients 18+ will need prior authorization for covered medications.
Action Required
Immediately: Billing team must update prior authorization workflows to require prior auth for Site of Care Management medications for patients ages 18+ (previously 22+). Review current pediatric patients aged 18-21 who may now require prior authorization for new requests or renewals. Visit Provider.MedMutual.com under Tools & Resources, Care Management, Medical Drug Management for the complete medication list subject to this policy.