Medicare AdvantageAdministrativeHigh impact
[Ohio] Next Generation MyCare quick reference guide
Anthem BCBS·OH·Provider Bulletin
Effective date
Jan 1, 2026
We identified it
May 27, 2026
Summary
Ohio MyCare Next Generation program launches in phases starting January 1, 2026, beginning with 29 counties where MyCare Ohio currently operates. Billing teams must implement new claims submission workflows for dual-eligible and Medicaid-only members, including new EDI payer ID (0022147) and different routing procedures based on member's primary Medicare coverage.
Action Required
By December 31, 2025: Billing team must update claims submission procedures for Ohio MyCare members. (1) Configure billing system to route dual-eligible member claims through 'one front door' using EDI payer ID# 0022147 or Direct Data Entry. (2) For Medicaid-only members with traditional Medicare as primary: submit claims to CMS (will auto-crossover). (3) For Medicaid-only members with Medicare Advantage as primary: submit to primary plan first, then to Anthem MyCare Ohio as secondary using EDI payer ID# 0022147 with primary payer information. (4) Route vision claims directly to EyeMed and dental claims to Liberty Dental. (5) Verify member's county is live on rollout schedule before applying new workflow; continue current process for non-live counties. (6) Update claim submission training materials and encounter forms. (7) Providers must complete credentialing through Join Our Network page (Medicare) and Become a Provider page (Medicaid) before submitting claims. Claims submitted without proper credentialing or through incorrect routing will be denied or delayed.