CommercialAdministrativeMedium impact
[Ohio] Continued collaboration on DRG clinical and coding validation
Anthem BCBS·OH·Coding
Effective date
Jul 23, 2026
We identified it
Jul 28, 2026
Summary
Anthem Blue Cross and Blue Shield in Ohio is continuing its DRG clinical and coding validation audit program through its Complex and Clinical Audit (CCA) team and designated external vendors (EXL and Ceris). Practices should expect ongoing medical record requests and audit correspondence from Anthem and/or vendor partners. The audit review processes remain consistent, with efforts to minimize duplicate medical record requests.
Action Required
Effective immediately (July 23, 2026): Medical billing and coding teams must ensure preparedness to respond to DRG validation audit requests from Anthem's Complex and Clinical Audit (CCA) team and designated vendors (EXL and Ceris). Establish a process to track and log all incoming medical record requests to identify and prevent duplicate requests. Designate a point of contact for audit correspondence and ensure timely submission of requested medical records. Notify providers to maintain accurate DRG coding documentation and clinical records to support validation audits. Failure to respond timely to audit requests may result in claims disputes or payment recoupment. Contact your Anthem provider relationship management representative for questions or clarification on audit procedures.