Medicare AdvantagePrior AuthHigh impact
[Ohio] Precertification/prior authorization requirement changes (September 2026 Newsletter)
Anthem BCBS·OH·Provider Bulletin
Effective date
Jan 1, 2027
We identified it
Aug 29, 2026
Summary
Anthem Blue Cross and Blue Shield (Ohio) is implementing precertification/prior authorization requirement changes effective January 1, 2027, affecting Medicare Advantage and MyCare Ohio plans. The specific requirements are not detailed in this newsletter summary and require accessing the full policy documentation through the provided link.
Action Required
By December 31, 2026: Billing team must access the full policy details at https://providernews.anthem.com/ohio/articles/precertificationprior-authorization-requirement-changes-sept-31998 to identify which services require new or modified prior authorization. Update billing software, encounter forms, and provider workflows to reflect all precertification/prior authorization requirement changes for Medicare Advantage and MyCare Ohio plans. Identify all affected CPT/HCPCS codes and implement system rules to require authorization before claim submission. Failure to obtain required prior authorizations will result in claim denials.