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[Ohio] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional
Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
Aug 3, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield is changing how unattended and/or home sleep studies must be billed in Ohio. These services must now be billed on CMS-1500 professional claim forms only and are NOT eligible for reimbursement when billed on UB-04 facility claim forms. This is a critical billing requirement change that affects claim submission method and provider credentialing.
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What to do
by Oct 31, 2026 · 8 steps
01Billing team must implement the following changes for all Anthem commercial claims in Ohio.
02Update billing system to route unattended and home sleep study claims to CMS-1500 professional claim forms ONLY—block any attempts to submit on UB-04 facility forms.
03Update provider training materials and billing workflows to clarify that home/unattended sleep studies are professional services, not facility services.
04Audit current sleep study billing patterns to identify any claims incorrectly submitted on UB-04 forms and contact Anthem for guidance on resubmission.
05Update encounter forms and superbills to designate home/unattended sleep studies as professional services.
06Communicate policy change to all sleep medicine providers and facility partners in Ohio to prevent billing errors.
07CONSEQUENCES: Claims submitted on UB-04 forms will be denied for reimbursement.
08Providers are prohibited from balance-billing members for this policy change.
Original notice
[Ohio] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — Professional
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Georgia] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — ProfessionalHighEffective Nov 1, 2026 · Claims & Billing[New York] Reimbursement policy update: Sleep Studies and Related Bundled Services and Supplies — ProfessionalHighEffective Nov 1, 2026 · Claims & BillingBrowse every Anthem BCBS change in the policy list