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Anthem BCBSMedicare Advantage · Billing Codes · Coding · OH · OB-GYNHigh impact

[Ohio] Telehealth claims update: ICD-10-CM Excludes1 editing

Act
by Aug 31, 2026
Effective date
Sep 1, 2026
Identified
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.

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What to do

by Aug 31, 2026 · 6 steps
01Billing 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.
02Providers must review current ICD-10-CM Excludes1 notes and audit recent telehealth claims for non-compliant diagnosis combinations (e.g., Z01.419 + Z12.4).
03Update telehealth encounter templates and clinical documentation guidelines to remind providers to verify diagnosis codes do not violate Excludes1 rules before finalizing.
04Train all coding and billing staff on Excludes1 application to telehealth.
05Failure to comply will result in claim denials and loss of reimbursement.
06Establish dispute resolution process using Availity.com or Provider Dispute Resolution Form for claims denied due to Excludes1 conflicts.

Codes mentioned

Z01.419Z12.4

Original notice

[Ohio] Telehealth claims update: ICD-10-CM Excludes1 editing
providernews.anthem.com · Always check the source before changing claims.
View original ↗

Related changes

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[Georgia] Telehealth claims update: ICD-10-CM Excludes1 editingHighEffective Sep 1, 2026 · Coding[California] Telehealth claims update: ICD-10-CM Excludes1 editingHighEffective Sep 1, 2026 · Coding[New York] Telehealth claims update: ICD-10-CM Excludes1 editingHighEffective Sep 1, 2026 · Coding[Virginia] Telehealth claims update: ICD-10-CM Excludes1 editingHighEffective Sep 1, 2026 · CodingBrowse every Anthem BCBS change in the policy list

Related policy hubs

Anthem BCBS policiesOH policy changesOB-GYNCode Z01.419Code Z12.4

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