[Ohio] Site of Care Program for surgical procedures expansion

By October 15, 2026: Billing and clinical teams must update workflows to implement new site of care prior authorization requirements for all surgical procedures scheduled at outpatient hospital settings in Ohio. (1) Update billing software and prior authorization submission processes to route all outpatient hospital surgical procedures through Carelon Medical Benefits Management for site of care review in addition to medical necessity review. (2) Educate providers and surgical scheduling staff that procedures may be redirected to ASCs or outpatient facilities when clinically appropriate; obtain updated site of care authorization before scheduling at hospital outpatient departments. (3) Obtain patient authorization and explain potential changes in procedure location and associated cost savings. (4) Contact Carelon Medical Benefits Management via Availity Chat (https://Availity.com) or the Anthem provider contact center with questions about specific CPT codes and clinical appropriateness criteria. Failure to obtain prior authorization for outpatient hospital surgical procedures will result in claim denials or payment at reduced rates.