Medicare AdvantagePrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement changes
Anthem BCBS·OH · Gastroenterology, Urology, Neurosurgery +6 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
Jun 13, 2026
Summary
Effective September 1, 2026, Anthem will require prior authorization for 24 new medical codes including gastroenterology tests, drug assays, neurostimulation procedures, and various surgical procedures for Medicare Advantage members in Ohio. Claims submitted without proper precertification may be denied payment.
Action Required
Before September 1, 2026: Billing team must update prior authorization system to require precertification for all 24 listed codes for Medicare Advantage members. Update scheduling workflows to obtain prior auth before procedures. Train staff on new requirements using Availity Essentials portal or Provider Services phone line. Claims without proper precertification will be denied payment.