[Ohio] MCG Care Guidelines 30th edition

By May 31, 2026: Billing team must coordinate with clinical and prior authorization departments to implement MCG Care Guidelines 30th edition. Specific actions: (1) Review and update prior authorization requirements in billing system for new guidelines in Behavioral Health (psychosocial education, ketamine for treatment-resistant depression), Inpatient & Surgical Care (transcatheter mitral valve repair), Recovery Facility Care (cardiac rehabilitation), and Chronic Care (pediatric bipolar disorder assessments); (2) Update encounter forms and clinical documentation templates to reflect new indications for dual organ transplants and transcatheter valve procedures; (3) Brief all providers on new guidelines, particularly cardiology, cardiothoracic surgery, psychiatry, and pediatric specialties; (4) Test updated prior authorization logic in billing software before June 1, 2026 effective date. Failure to implement these changes may result in claim denials for procedures submitted without appropriate prior authorization under the new guidelines. Contact Anthem Provider Services for clarification on specific coding and authorization requirements.