MedicaidAdministrativeMedium impact
[Ohio] Continued collaboration on DRG clinical and coding validation
Anthem BCBS·OH·Coding
Effective date
Jul 22, 2026
We identified it
Jul 23, 2026
Summary
Anthem Blue Cross and Blue Shield Ohio Medicaid will continue conducting DRG clinical and coding validation audits through its Complex and Clinical Audit (CCA) team and designated external vendors (EXL and Ceris). Network providers may receive medical record requests and audit correspondence from Anthem and/or vendor partners. The review process remains consistent, with efforts to minimize duplicate requests.
Action Required
By July 22, 2026 and ongoing: Billing and clinical teams must be prepared to respond to DRG validation audit requests from Anthem's Complex and Clinical Audit (CCA) team and/or designated vendors (EXL and Ceris). Establish a process to track and respond to medical record requests promptly to avoid claim denials or audit delays. Designate a point of contact for medical record request coordination to facilitate communication with Anthem and vendor partners and help minimize duplicate requests. Alert clinical and coding staff that audit correspondence may come from external vendors, not solely from Anthem directly.