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[Ohio] Precertification/prior authorization requirement changes
Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Aug 21, 2026
Summary
Effective January 1, 2027, Anthem Blue Cross and Blue Shield is adding precertification/prior authorization requirements for ambulance services (code A0999) for all Fully Integrated Dual Eligible (FIDE) plans in Ohio. Claims submitted without prior authorization for these services may be denied as ineligible for payment.
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What to do
by Dec 31, 2026 · 4 steps
01Billing team must update billing system to require prior authorization for HCPCS code A0999 (Unlisted Ambulance Service) for all Ohio MyCare Ohio FIDE plan members.
02Front desk and scheduling staff should be notified to flag ambulance service requests for prior auth review before service delivery.
03Train billing staff to submit prior authorization requests through Availity or by contacting Anthem Provider Services at 833-727-2170.
04Update encounter forms and workflows to include prior authorization checkpoints for ambulance services.
If missed: Failure to obtain required prior authorization will result in claim denials for Anthem FIDE members in Ohio.
Codes mentioned
A0999
Original notice
[Ohio] Precertification/prior authorization requirement changes
providernews.anthem.com · Always check the source before changing claims.
Related changes
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