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[Ohio] New reimbursement policy: Inpatient Hospital Inclusive Services — Facility
Effective date
Feb 1, 2027
Identified
Nov 3, 2026
Summary
Effective February 1, 2027, Anthem Blue Cross Blue Shield in Ohio will no longer separately reimburse certain inpatient hospital services (blood products, DME, nursing, pharmacy, therapy, radiology guidance, diagnostic services, professional services like catheter insertion and chemotherapy administration, and outpatient clinic/treatment room services) when billed on the same date as an inpatient admission. The practice must stop billing these services separately for inpatient stays or resubmit claims with appropriate bundling to avoid denials.
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What to do
Action · 6 steps
01Before February 1, 2027.
02Billing team: Review the full Ohio reimbursement policy at the Anthem provider portal to identify all applicable service codes and update charge entry edits so that claims do not separately bill bundled services (blood products, DME, setup/delivery/accessories, nursing, pharmacy, flushes/diluents, feeding kits, pulse oximetry, radiology guidance, routine supplies, therapy services, ECG, chemotherapy administration, infusion drug administration, bladder catheter insertion, treatment room, and clinic services) when reported on the same date of service as an inpatient semi-private room (room and board) charge.
03Tell providers and front desk staff that professional services (blood product administration, chemotherapy administration, infusion drug administration, bladder catheter insertion, routine ECG) must be reported on CMS-1500/837P claim forms (not UB-04) to be eligible for separate reimbursement; when billed on UB-04 on the same inpatient date, they will be denied as included in facility reimbursement.
04Update internal billing guidelines to reflect that outpatient services (treatment room, clinic services) are not separately reimbursable when reported on the same date as an inpatient admission.
05Watch for claim denials after February 1, 2027 for any bundled services submitted on inpatient dates and resubmit with corrected claim forms or dates of service as appropriate.
06Confirm the practice will not balance bill members for services that are now included in inpatient facility reimbursement.
Original notice
[Ohio] New reimbursement policy: Inpatient Hospital Inclusive Services — Facility
providernews.anthem.com · Always check the source before changing claims.
Related changes
See all Anthem BCBS changes →[New York] New reimbursement policy: Inpatient Hospital Inclusive Services — FacilityHighEffective Feb 1, 2027 · Claims & Billing[Georgia] New reimbursement policy: Inpatient Hospital Inclusive Services — FacilityHighEffective Feb 1, 2027 · Claims & BillingBrowse every Anthem BCBS change in the policy list