Medicare AdvantageAdministrativeMedium impact
[Ohio] Claims processing for MyCare Full‑Dual Eligible members
Anthem BCBS·OH·Provider Bulletin
Effective date
Apr 14, 2026
We identified it
May 3, 2026
Summary
Anthem clarifies claims processing procedures for MyCare Full-Dual Eligible members in Ohio (those receiving both Medicare and Medicaid through Anthem). Billing teams must submit a single claim per service, which will be processed with Medicare as primary payer and Medicaid as secondary on the same claim ID and remittance advice. Services covered only by Medicaid will receive a Medicare disallow code B59 and be paid at the Medicaid allowable amount.
Action Required
By April 14, 2026 (effective date): Billing team must ensure all claims for MyCare Full-Dual Eligible members are submitted as single claims (not split). Update billing software and staff training to reflect: (1) Medicare processes first at CMS allowable rate; (2) Medicaid processes second at Ohio Medicaid fee schedule; (3) both appear on same remittance advice under single claim ID; (4) services covered only by Medicaid will show disallow code B59 on Medicare portion but pay Medicaid allowable as primary. Verify that your system does not automatically split dual-eligible claims. Contact ohiomedicaidprovider@anthem.com with questions. Failure to submit single claims may result in processing delays and duplicate claim submissions.