Medicare AdvantageReimbursementHigh impact
[Ohio] Reimbursement policy update: Preventive Medicine and Sick Visits on the Same Day
Anthem BCBS·OH·Claims & Billing
Effective date
Apr 1, 2026
We identified it
May 3, 2026
Summary
Effective April 1, 2026, Anthem Medicare Advantage plans in Ohio will reimburse sick visits on the same day as preventive/wellness visits at 50% of the applicable fee schedule or contracted rate. Additionally, preventive services billed on the same day as wellness visits will also be reimbursed at 50%. This requires billing teams to identify same-day visit combinations and apply the 50% reduction to applicable claims.
Action Required
By March 31, 2026: Billing team must implement system logic to identify and flag claims where sick visits and preventive/wellness visits occur on the same date of service. Configure billing software to automatically apply 50% reimbursement reduction to the applicable service(s) on same-day encounters for Anthem Medicare Advantage plans in Ohio. Providers and front desk staff must document visit type (sick vs. preventive/wellness) in the EMR/encounter form. Update claim submission processes to ensure correct fee schedule application. Failure to apply the 50% reduction will result in overpayment recovery by Anthem.