[Ohio] SSBCI eligibility requirements and care provider requests for our members

Immediately (effective October 1, 2026): Clinical and billing teams must implement the new SSBCI eligibility validation process. (1) Providers must obtain and complete Anthem's SSBCI attestation form for eligible members, documenting: qualifying chronic condition from EOC, AND evidence of recent utilization (inpatient admission, ER/urgent care visit, 2+ outpatient visits, home health, functional/cognitive impairment, or specific DME in groups 2-3). Forms must be submitted via fax, Availity Essentials portal, or oral attestation to Provider Services. (2) Billing team must ensure no SSBCI benefits (healthy foods, utilities, etc.) are processed for members until Anthem validates eligibility through claims history review or provider attestation. (3) For new Anthem members, coordinate with providers to complete forms during pre-enrollment or at first visit to expedite benefit activation. (4) Update clinical encounter templates and patient outreach materials to reference the qualifying chronic condition list and Clinical Guidelines. Consequence: Members will be unable to access SSBCI benefits until eligibility is validated; delays in form submission will delay benefit access and may affect member satisfaction.