MedicaidAdministrativeLow impact
[Ohio] Insights on utilization management for care providers
Anthem BCBS·OH·Prior Authorization
Effective date
Jun 2, 2026
We identified it
Jun 3, 2026
Summary
Anthem Blue Cross Blue Shield Ohio Medicaid has published updated utilization management (UM) guidance clarifying their prior authorization processes, contact procedures, and submission methods. This is an informational policy reinforcing existing UM protocols with no substantive changes to authorization requirements—it serves as a reference guide for providers on how to submit prior auth requests and escalate UM denial decisions.
Action Required
Ongoing compliance: Billing team should ensure all prior authorization requests for Ohio Medicaid members are submitted via Availity Essentials (https://Availity.com) or by fax using the appropriate specialty fax numbers provided (877-643-0671 for inpatient physical health, 877-643-0672 for outpatient physical health, 866-577-2184 for inpatient behavioral health, 866-577-2183 for outpatient behavioral health, 800-563-5581 for medical injectables). For expedited processing, use Anthem's prior authorization template form available at https://anthem.com/oh/provider > Resources > Forms. If a prior auth request is denied, contact physician reviewers within 7 calendar days at 833-308-3035 (medical/physical health) or 844-441-1506 (behavioral health) to discuss and potentially resolve the denial. UM clinical professionals are available at 844-912-1226 Monday-Friday 8 a.m.–5 p.m. ET, with 24/7 inpatient authorization support available via voicemail with next-business-day callback. No immediate system updates are required, but team should bookmark the referenced URLs and contact numbers for reference.