Medicare AdvantagePrior AuthHigh impact
[Ohio] Precertification/prior authorization requirement changes
Anthem BCBS·OH · Neurology, Gastroenterology, Infectious Disease +7 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Jun 17, 2026
Summary
Effective September 1, 2026, Anthem will require precertification/prior authorization for 29 new medical codes including diagnostic tests, surgical procedures, and specialized treatments for MyCare Ohio FIDE (Fully Integrated Dual Eligible) members. Services performed without proper authorization may be denied payment.
Action Required
Before September 1, 2026: Billing team must update prior authorization system to require precertification for all 29 listed codes when treating MyCare Ohio FIDE members. Update encounter forms and billing software to flag these codes. Train staff to obtain authorization through Availity Essentials or by calling 833-727-2170. Claims without proper authorization will be denied payment.