MedicaidPrior AuthHigh impact
[Ohio] Reminder: prior authorization and Continuity of Care guidelines
Anthem BCBS·OH · Oncology, Nephrology, Hematology +4 more·Provider Bulletin
Effective date
Jul 9, 2026
We identified it
Jul 10, 2026
Summary
Anthem Blue Cross and Blue Shield (MyCare Ohio) is reminding providers of mandatory Continuity of Care (COC) guidelines during member transitions to Anthem. Providers must obtain prior authorization before rendering services or risk claim denials; retro authorization is not permitted. The policy establishes specific transition periods (45-180 days depending on service type) during which current providers and service levels must be maintained.
Action Required
Immediately: (1) Billing team must verify all services requiring prior authorization using the Anthem prior authorization lookup tool before rendering care. (2) Update billing workflow to ensure NO services are delivered without confirmed prior authorization—Anthem does not allow retroactive authorization. (3) Train all clinical and administrative staff that claims submitted without pre-service authorization will be denied and require backend dispute/appeal. (4) For Continuity of Care transitions: Maintain current providers and service levels per the policy table (180 days for physicians, dialysis, HCBS waivers; 90 days for home health/PDN; 45 days for OhioRISE; specified periods for behavioral health, waiver services, and other categories). (5) Document all transition timelines in the billing system to prevent unauthorized service changes. (6) Contact Anthem Provider Relationship Account Management (ohiomedicaidprovider@anthem.com) for clarification on COC requirements before service authorization. Failure to obtain prior authorization will result in claim denials that require appeal—claims cannot be retroactively authorized.