All PlansReimbursementHigh impact
Mutual News September 2025 Bulletin
Medical Mutual of Ohio·OH·Mutual News Bulletin
Effective date
Sep 29, 2025
We identified it
Jun 20, 2026
Summary
Medical Mutual is implementing multiple policy updates including high-cost specialty drug management changes (effective Dec 15, 2025), MS-DRG payment methodology updates (effective Oct 15, 2025), new reimbursement policies for multiple procedures and discontinued services (effective Oct 15, 2025), and updated anesthesia policies (effective Sept 29, 2025). New call procedures requiring NPI/TIN verification are already in effect as of Sept 15, 2025.
Action Required
By September 29, 2025: Review updated Anesthesia Reimbursement Policy (RP-202502) at MedMutual.com/Provider and update billing procedures accordingly. By October 15, 2025: Review new Multiple Procedure Payment Reduction policy (RP-202514) and Reduced and Discontinued Services policy (RP-202515), and update billing system rules for multiple procedure reductions. Review updated MS-DRG and GMLOS payment methodology changes in Provider Manual Section 9, Page 69. By December 15, 2025: Review High-Cost Outlier Specialty Drugs updates in Provider Manual Section 2, Page 22 and update drug management billing procedures. Immediately: All staff must use NPI or TIN when calling Medical Mutual and verify member identity before accessing member information.