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Anthem BCBSCommercial · Coverage · Claims & Billing · CT, GA, IN, KY, MO, NV, NH, NY, OH, WIHigh impact

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

Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
Jul 2, 2026

Summary

Anthem is implementing a Provider Preventable Conditions (PPC) reimbursement policy effective October 1, 2026, that denies reimbursement for claims containing Never Event diagnosis codes, specifically HAC01 (retention of foreign object after surgery). This policy applies to professional and facility claims in Ohio and nine other states. Providers are prohibited from balance billing members for denied claims under this policy.

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What to do

by Sep 15, 2026 · 6 steps
01Billing 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.
02Update billing software validation rules to reject claims with HAC01 and related services before submission to Anthem.
03Train all billing and coding staff to recognize Never Event diagnoses and ensure providers document appropriately to avoid these codes when conditions are preventable.
04Implement internal audit procedures to monitor for HAC01 coding and implement provider education.
05Ensure all staff understand that balance billing is prohibited for denials under this policy.
06Review 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.

Original notice

[Ohio] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility
providernews.anthem.com · Always check the source before changing claims.
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Related changes

See all Anthem BCBS changes →
[New York] Reimbursement policy reminder: Provider Preventable Conditions — Professional and FacilityHighEffective Oct 1, 2026 · Claims & Billing[Georgia] Reimbursement policy reminder: Provider Preventable Conditions — Professional and FacilityHighEffective Oct 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list

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