MedicaidAdministrativeMedium impact
[Ohio] OhioRISE eligibility and enrollment update effective
Anthem BCBS·OH · Psychiatry, Pediatrics·Network
Effective date
Jul 1, 2026
We identified it
May 3, 2026
Summary
Effective July 1, 2026, OhioRISE enrollment will now become effective on the first day of the calendar month of eligibility (rather than mid-month), aligning with managed care enrollment timelines and reducing manual retroactive enrollments caused by inpatient behavioral health admissions. This affects Ohio Medicaid beneficiaries in the OhioRISE program and may impact billing timelines for behavioral health services.
Action Required
By June 1, 2026: Billing team must review and update enrollment verification processes to account for first-of-month OhioRISE effective dates. Update billing system logic to recognize OhioRISE eligibility beginning on the first day of the month rather than other dates. Coordinate with behavioral health/inpatient admissions teams to align claim submission and prior authorization timelines with the new enrollment effective date. Contact the Provider Relationship Account Management team at ohiomedicaidprovider@anthem.com if clarification is needed on financial responsibility for behavioral health services. Failure to align billing practices may result in claim denials or delays due to retroactive enrollment adjustments.