MedicaidPrior AuthHigh impact
[Ohio] Required NPI information to prevent utilization management notification delays
Anthem BCBS·OH·Prior Authorization
Effective date
Aug 1, 2026
We identified it
Aug 3, 2026
Summary
Anthem Blue Cross and Blue Shield Medicaid (MyCare Ohio) now requires providers to include complete National Provider Identifier (NPI) information—including the ordering/requesting practitioner's NPI in addition to the servicing provider or facility NPI—on all prior authorization requests submitted through Availity Essentials or by fax, effective August 1, 2026. Failure to include sufficient provider information may result in prior authorization denials and processing delays.
Action Required
By August 1, 2026: Billing team and providers must update all prior authorization submission processes to require and include: (1) the servicing provider or facility NPI, and (2) the ordering or requesting treatment practitioner's NPI when applicable. Update Availity Essentials submission templates, fax cover sheets, and billing system workflows to capture and verify both NPIs before submission. Train all staff submitting prior authorization requests (billing team, authorization coordinators, clinical staff) on this requirement. Document this requirement in internal compliance procedures. Consequence: Prior authorization requests with incomplete provider information will be denied, resulting in claim rejections and potential service delays for members. The submitting provider or facility UR Department must also ensure determinations are shared with all involved practitioners.