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[Ohio] National accounts: 2027 standard prior authorization requirements
Act
by Dec 15, 2026
Effective date
Jan 1, 2027
Identified
Oct 2, 2026
Summary
Anthem Blue Cross and Blue Shield Ohio is implementing updated prior authorization requirements for national accounts effective January 1, 2027. This comprehensive policy change expands PA requirements across inpatient admissions, advanced diagnostic testing, specialized DME/prosthetics, gene therapies, CAR T-cell treatments, mental health services, and numerous surgical procedures. Billing teams must identify all affected services and update authorization workflows to avoid claim denials.
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What to do
by Dec 15, 2026 · 9 steps
01Billing team must conduct comprehensive audit of current billing workflows to identify all services listed in this policy that your practice performs.
02Before January 1, 2027.
03Update billing system to flag ALL services requiring prior authorization under this policy, including inpatient admissions (acute, rehab, LTACH, SNF, OB delivery), advanced genetic/diagnostic testing, specialized DME (AAC devices, brain-computer interfaces, functional electrical stimulation, prosthetics, compression devices, exoskeletons, etc.), gender-affirming surgery, organ/bone marrow transplants, CAR T-cell therapies, gene replacement therapies, mental health/substance abuse services (inpatient admits, TMS, residential care, ABA, IOP, PHP), and numerous outpatient/surgical services (bariatric surgery, cardiac procedures, implantable devices, cosmetic/reconstructive surgery, and others as listed).
04Create pre-authorization checklist for clinical and billing staff identifying which encounters require PA initiation.
05Update provider encounter forms and EMR templates to include PA requirement reminders.
06Train all front-desk, clinical, and billing staff on new requirements with emphasis on specialties performing affected procedures.
07Establish process to monitor for retroactive denials due to missed prior authorizations.
08Consequences: Claims submitted without required prior authorization will be denied by Anthem, resulting in revenue loss and potential patient balance issues.
09Emergency inpatient admissions do not require pre-certification but plan notification must be provided as soon as possible.
Original notice
[Ohio] National accounts: 2027 standard prior authorization requirements
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[Ohio] National accounts: 2027 standard prior authorization requirementsHighEffective Jan 1, 2027 · Provider Bulletin[California] National accounts: 2027 prior authorization requirementsMediumEffective Jan 1, 2027 · Provider Bulletin[New York] National accounts: 2027 standard prior authorization requirementsHighEffective Jan 1, 2027 · Provider Bulletin[Ohio] Prior authorization requirement changes (October 2026 Newsletter)HighEffective Jan 1, 2027 · Provider BulletinBrowse every Anthem BCBS change in the policy list