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Anthem BCBSMedicare Advantage · Prior Auth · Provider Bulletin · OHHigh impact

[Ohio] Post-acute care authorization process changes

Act
by Dec 31, 2026
Effective date
Jan 1, 2027
Identified
Oct 2, 2026

Summary

Effective January 1, 2027, Anthem Blue Cross and Blue Shield (MyCare Ohio) is transferring prior authorization and concurrent review for post-acute care services (home health, DME, SNF, IRF, LTACH) from Anthem to Carelon Medical Benefits Management. Providers must submit all new authorization requests through the Carelon provider portal or fax starting January 1, 2027, while continued-stay reviews for patients admitted before that date remain with Anthem.

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What to do

by Dec 31, 2026 · 5 steps
01Billing and clinical staff must register for and gain access to the Carelon provider portal at Carelon Portal Login.
02Update all internal workflows, encounter forms, and billing system documentation to direct post-acute care prior authorization requests to Carelon (portal or fax 833-311-2986) effective January 1, 2027.
03Train billing team, care coordinators, and discharge planners on the new submission process and portal functionality.
04Maintain separate processes: route NEW authorization requests (HH, DME, SNF, IRF, LTACH admissions/continued stay) to Carelon; route continued-stay reviews for patients admitted BEFORE January 1, 2027 to Anthem.
05Bookmark Carelon customer service contact (844-411-9622) for staff reference.
If missed: Failure to use the correct authorization vendor will result in delayed or denied approvals and claim denials.

Original notice

[Ohio] Post-acute care authorization process changes
providernews.anthem.com · Always check the source before changing claims.
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