[Ohio] March 2026 Provider Newsletter

By May 15, 2026: Billing team must implement the following changes for Anthem Ohio plans: (1) For inpatient sepsis and newborn DRG submissions (effective June 1, 2026), ensure full medical records are submitted with all claims to meet enhanced claims accuracy requirements—update billing system to flag these claim types and attach complete documentation; (2) Update prior authorization protocols for MyCare Ohio effective June 1, 2026 per precertification/prior authorization requirement changes—obtain updated prior auth requirements list from Anthem and modify authorization workflows; (3) Implement MCG Care Guidelines 30th edition (effective June 1, 2026) across all clinical decision-making and prior authorization reviews—train billing and clinical staff on guideline updates; (4) Review and update bundled services and supplies reimbursement policies for facility claims effective June 1, 2026—verify which services/supplies are bundled vs. separately billable; (5) Update specialty pharmacy billing per March 2026 updates effective June 1, 2026; (6) For outpatient facility claims, ensure correct application of modifier 26 (professional services) on UB-04 forms effective April 1, 2026; (7) Verify assistant surgeon billing with payment indicator 2 is being submitted correctly per reimbursement policy. Implementation team should update billing system rules, train staff, and communicate changes to providers. Failure to submit complete medical records for sepsis/newborn cases or follow new prior authorization requirements will result in claim denials.