[Ohio] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility

By September 15, 2026: Billing team must update claims processing system to identify and flag claims containing Never Event diagnosis codes (specifically HAC01 - retention of foreign object after surgery) for automatic denial without reimbursement. Update billing software validation rules to reject claims with HAC01 and related services before submission to Anthem. Train all billing and coding staff to recognize Never Event diagnoses and ensure providers document appropriately to avoid these codes when conditions are preventable. Implement internal audit procedures to monitor for HAC01 coding and implement provider education. Ensure all staff understand that balance billing is prohibited for denials under this policy. Review current claims history for any potential retroactive recoupment liability dating back to the originally announced effective date, as Anthem reserves the right to recover payments retroactively.