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Anthem BCBSMedicare Advantage · Documentation · Coding · OHHigh impact

[Ohio] Enhancing claims accuracy: expansion of inpatient high-impact DRG submissions with full medical records (October 2026 Newsletter)

Effective date
Jan 1, 2027
Identified
Oct 2, 2026

Summary

Anthem Blue Cross and Blue Shield is expanding requirements for inpatient high-impact DRG submissions to include full medical records, effective January 1, 2027. This change applies to both Commercial and Medicare Advantage plans in Ohio and may affect claims accuracy and submission processes for inpatient admissions.

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What to do

Action · 4 steps
01Before January 1, 2027: Billing and coding teams must review the complete policy details at https://providernews.anthem.com/ohio/articles/enhancing-claims-accuracy-expansion-of-inpatient-high-impact-32616 to identify which DRGs are considered 'high-impact' and require full medical records submission.
02Update billing workflows and claim submission processes to ensure complete medical record documentation is attached to all qualifying inpatient claims.
03Coordinate with clinical documentation and HIM departments to establish procedures for compiling and submitting full medical records with affected claims.
04Train billing staff on new submission requirements and update system templates/checkpoints.
If missed: Failure to include required documentation may result in claim denials or delays.

Original notice

[Ohio] Enhancing claims accuracy: expansion of inpatient high-impact DRG submissions with full medical records (October 2026 Newsletter)
providernews.anthem.com · Always check the source before changing claims.
View original ↗

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