MedicaidAdministrativeHigh impact
[Ohio] Home healthcare, waiver home health services, and private duty nursing authorization requests
Anthem BCBS·OH · Geriatrics, Palliative Care, Wound Care·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Sep 2, 2026
Summary
Anthem Ohio Medicaid and MyCare Ohio now require home healthcare, waiver home health services, and private duty nursing authorization requests to calculate units using a standardized conversion: 1 unit = 15 minutes (4 units per hour). Claims submitted with units that don't align with authorized service time may be denied and require corrected claim submission. Billing teams must ensure all authorization requests and subsequent claims use this conversion formula.
Action Required
By September 1, 2026: Billing team must implement the following: (1) Update all authorization request templates and processes to calculate units using the 15-minute conversion (multiply total hours by 4 to derive units); (2) Train all staff submitting home healthcare, waiver home health services, and private duty nursing authorizations on the correct unit calculation; (3) Audit billing system logic to ensure claims automatically validate that submitted units align with authorized service times; (4) Review pending authorization requests to verify they use correct unit calculations before submission to Anthem; (5) Establish a quality check process to flag claims with misaligned units before submission. Failure to comply will result in claim denials and administrative burden of corrected claim submissions for Anthem Blue Cross and Blue Shield Medicaid and MyCare Ohio members in Ohio.