MedicaidAdministrativeHigh impact
[Ohio] New requirement effective
Anthem BCBS·OH·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
Jun 11, 2026
Summary
Effective July 1, 2026, Anthem Blue Cross and Blue Shield Medicaid and MyCare Ohio will reject claims if the provider's group affiliation data is missing or inactive in the Ohio Department of Medicaid (ODM) Provider Network Management (PNM) system. Providers must ensure their group affiliations are current and active as of the date of service, or claims will not be accepted for payment.
Action Required
By June 30, 2026: Billing team and providers must verify that all group affiliations are correctly registered and active in the Ohio Department of Medicaid (ODM) Provider Network Management (PNM) system. Contact your Provider Relationship Account Team or email ohiomedicaidprovider@anthem.com to confirm group affiliation status. Audit all claims currently billed under group affiliations to ensure provider data exists within those groups in PNM. Update internal provider records and billing system to flag any missing or inactive group affiliations. Beginning July 1, 2026, any claim submitted with a group affiliation where the provider's data is not active in PNM will be denied. This will directly impact claim acceptance and payment processing.