CommercialDocumentationMedium impact

[Ohio] Genetic testing claims for FEP members: medical records required for review

Q: Who is affected by this change?

This affects Anthem BCBS Family Medicine, Internal Medicine, Oncology, OB-GYN, Pediatrics providers in OH on Commercial plans.

Anthem BCBS·OH · Family Medicine, Internal Medicine, Oncology +2 more·Provider Bulletin

Effective date

Not stated

We identified it

May 29, 2026

Days to comply

—

Summary

Anthem Ohio now requires medical records to be submitted for review with all genetic testing claims for Federal Employee Program (FEP) members. This adds a documentation requirement that could delay claim processing if records are not included.

Action Required

Action needed

Immediately: Billing team must update procedures to include medical records with all genetic testing claims for FEP members in Ohio. Update billing workflows to flag FEP genetic testing claims for record attachment before submission. Claims may be delayed or denied without proper medical record documentation.

Related policy hubs

Anthem BCBS policies OH policy changes Family Medicine Internal Medicine Oncology OB-GYN Pediatrics