Medicare AdvantageAdministrativeMedium impact
Mutual News October 2025 Newsletter
Medical Mutual of Ohio·Endocrinology, Oncology, Hematology·Mutual News Newsletter
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Medical Mutual's October 2025 newsletter announces multiple updates including expanded Optum network for CAR-T and Gene Therapies effective January 1, 2026, new requirements for Continuous Glucose Monitor documentation with 6-month follow-up visits for Medicare Advantage and annual orders for all plans, and discontinuation of paper claims as of September 1, 2025 requiring all claims to be submitted electronically.
Action Required
By January 1, 2026: Submit CAR-T and Gene Therapy claims directly to Optum network instead of Medical Mutual. Immediately: For CGM patients, ensure DME suppliers receive 6-month office visit notes for Medicare Advantage members and annual detailed written orders for all members to prevent delayed shipments. Billing team must transition all claims to electronic submission via clearinghouse or Availity portal - paper claims are no longer accepted except with approved waiver.