Medicare AdvantagePrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement changes
Anthem BCBS·OH · Palliative Care, Geriatrics, Wound Care·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 7, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield will require prior authorization for home health/hospice aide services (HCPCS code G0156) for all Fully Integrated Dual Eligible (FIDE) plans in Ohio. Claims submitted without prior authorization may be denied as ineligible for payment.
Action Required
By December 15, 2026: Billing team must update all billing system workflows and encounter forms to require prior authorization for HCPCS code G0156 (home health/hospice aide services, 15-minute intervals) for all Ohio MyCare Ohio FIDE plan members. Providers should obtain prior authorization through Availity or by calling Anthem Provider Services at 833-727-2170 before submitting claims. Front desk and scheduling staff must flag G0156 services during intake to ensure authorization requests are initiated timely. Claims submitted for G0156 without prior authorization will be denied as ineligible for payment. Appeals with supporting medical records can be submitted through Availity or by phone.