MedicaidPrior AuthMedium impact
[Ohio] Medical Policies and Clinical Utilization Management Guidelines update
Anthem BCBS·OH · Pulmonology, Pain Management, Endocrinology·Prior Authorization
Effective date
Jun 12, 2026
We identified it
Jun 13, 2026
Summary
Anthem Blue Cross Blue Shield Ohio updated three Clinical Utilization Management Guidelines for Medicaid members: Vitamin D Testing (CG-LAB-11), Inhaled Nitric Oxide (CG-MED-69), and Implantable Infusion Pumps (CG-SURG-79). These revisions may include changes to medical necessity criteria that could affect coverage decisions for previously covered services.
Action Required
By June 12, 2026: Review the updated Clinical UM Guidelines at the Medical Policies & Clinical UM Guidelines website for specific changes to Vitamin D Testing, Inhaled Nitric Oxide, and Implantable Infusion Pumps. Update billing workflows and prior authorization processes for these services according to revised medical necessity criteria. Share this notice with all providers and office staff to ensure compliance with new guidelines.