ExchangeAdministrativeMedium impact
[Ohio] EMR alerts aim to close gaps in care for Affordable Care Act members
Anthem BCBS·OH·Provider Bulletin
Effective date
May 1, 2026
We identified it
May 3, 2026
Summary
Anthem Blue Cross Blue Shield is implementing EMR alerts for ACA-compliant plan members to identify and close care gaps for chronic conditions. Providers will receive notifications in their EMR systems flagging patients who need follow-up care, with the expectation that practices will schedule visits, complete clinical assessments, and submit claims with high-specificity coding and complete clinical documentation.
Action Required
By May 1, 2026: Providers and billing staff must be prepared to receive and act on EMR alerts from Anthem for ACA members with care gaps. Ensure providers review alerts in the EMR and document all clinical assessments thoroughly. Billing team must verify that all claims submitted for flagged patients include highest-specificity coding and complete clinical documentation to support risk adjustment requirements. Contact the Commercial Risk Adjustment team at prospectiveteam@anthem.com with questions. Failure to address care gaps and provide complete documentation may result in claim denials or compliance issues with ACA reporting requirements.