Medicare AdvantageBilling CodesHigh impact
[Ohio] Telehealth claims update: ICD-10-CM Excludes1 editing
Anthem BCBS·OH · OB-GYN·Coding
Effective date
Sep 1, 2026
We identified it
Jul 21, 2026
Summary
Beginning September 1, 2026, Anthem will apply ICD-10-CM Excludes1 editing rules to telehealth claims billed with POS 02 or POS 10, matching standards already applied to in-person claims. Claims with prohibited diagnosis code combinations per Excludes1 notes may be denied for reimbursement. Providers must verify diagnosis codes comply with Excludes1 conventions before submission.
Action Required
By August 31, 2026: (1) Billing team must update claim scrubbing logic in billing software to apply ICD-10-CM Excludes1 validation to all telehealth claims (POS 02 and POS 10), blocking submission of prohibited diagnosis code combinations. (2) Providers must review current ICD-10-CM Excludes1 notes and audit recent telehealth claims for non-compliant diagnosis combinations (e.g., Z01.419 + Z12.4). (3) Update telehealth encounter templates and clinical documentation guidelines to remind providers to verify diagnosis codes do not violate Excludes1 rules before finalizing. (4) Train all coding and billing staff on Excludes1 application to telehealth. Failure to comply will result in claim denials and loss of reimbursement. Establish dispute resolution process using Availity.com or Provider Dispute Resolution Form for claims denied due to Excludes1 conflicts.