← Back to list
[Ohio] Precertification/prior authorization requirement changes
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Aug 12, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage in Ohio is adding five new codes to its precertification/prior authorization requirements. Providers must obtain prior authorization before delivering services under codes 0591U, 64624, A4479, A9294, and L2221, or claims may be denied as ineligible for payment. This change applies only to Anthem Medicare Advantage members in Ohio.
Get alerts when payers change rules like this one
We check Anthem BCBS and other payers every day and email you when a change matches your specialty and state.
Get Anthem BCBS alertsPolicy Monitoring is free. No card required.
What to do
by Dec 31, 2026 · 5 steps
01Billing and clinical teams must update internal processes and billing software to flag and require prior authorization for codes 0591U, 64624, A4479, A9294, and L2221 for all Anthem Medicare Advantage members in Ohio.
02Add these codes to precertification workflow and encounter forms/order entry systems.
03Train providers and front-desk staff to initiate prior authorization requests through Availity or by phone (Provider Services number on member ID card) before scheduling or delivering these services.
04Failure to obtain precertification will result in claim denials and loss of payment eligibility.
05Establish internal tracking to monitor submission status and appeal any denials with medical records documentation through Availity or Provider Services.
Codes mentioned
64624A4479A9294L2221
Original notice
[Ohio] Precertification/prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Georgia] Precertification/prior authorization requirement changesMediumEffective Jan 1, 2027 · Provider Bulletin[California] Precertification/prior authorization requirement changesMediumEffective Dec 1, 2026 · Provider Bulletin[California] Precertification/prior authorization requirement changesMediumEffective Jan 1, 2027 · Provider Bulletin[New York] Precertification/prior authorization requirement changesMediumEffective Jan 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list