---
title: Anthem Ohio Medicaid ABA coverage (Next Gen MCO).
url: "https://carelu.com/payers/anthem-ohio-medicaid"
markdown_url: "https://carelu.com/payers/anthem-ohio-medicaid.md"
state: OH (Ohio)
payer: Anthem BCBS Ohio (Medicaid)
kind: Medicaid managed care plan (MCO)
parent_program: Ohio Medicaid
description: "How Anthem administers Ohio Medicaid ABA — the adopted CG-BEH-02 adaptive behavioral treatment guideline on top of OAC 5160-34, Availity/ICR submission, and EPSDT framing for under-21 members."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# Anthem Ohio Medicaid ABA coverage (Next Gen MCO).

_Payer Guide · Anthem (OH Medicaid) · Last updated October 2026 · 10 primary sources_

> CG-BEH-02 adopted on top of the state rule; Availity/ICR, EPSDT framing in the provider manual.

Anthem Blue Cross and Blue Shield administers Ohio Medicaid ABA by adopting its corporate Clinical UM Guideline CG-BEH-02 (Adaptive Behavioral Treatment) on top of the state rule — the same guideline family it applies in Georgia and elsewhere, bringing hour parameters and supervision ratios the state rule doesn't specify. The provider manual frames ASD services for under-21 members squarely under EPSDT: medically necessary services can exceed adult plan limits.

This plan administers the **Ohio Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Ohio Medicaid guide](https://carelu.com/payers/ohio-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(ask the plan)_: Not published — the assessment-versus-treatment PA split is not stated for Ohio Medicaid; run the codes through the PA lookup tool at providers.anthem.com/oh per case and submit via Availity Essentials / Interactive Care Reviewer
  - Ask the plan: Anthem's Ohio Medicaid PA lookup tool at providers.anthem.com/oh, per code and per member, with the answer taken in writing before submitting through Availity Essentials / Interactive Care Reviewer. Anthem publishes no assessment-versus-treatment PA split for Ohio Medicaid, so this is settled case by case, not by a document.
- **Prior auth for treatment:** Not published / unverified. Verify via: Anthem OH Medicaid provider manual + the plan's Clinical UM Guidelines list — neither states the ABA authorization span or code set; request the current behavioral-health UM guidance from Anthem provider services or via carelu.com/sources.

## At a glance

- **Plan type:** Ohio Next Generation MCO
- **Clinical rules:** CG-BEH-02 adopted (per the plan's Clinical UM Guidelines list)
- **Prior auth:** Via Availity Essentials / Interactive Care Reviewer
- **Hour parameters:** Not published for Anthem Ohio Medicaid — confirm with Anthem UM
- **EPSDT:** Under-21 services may exceed adult limits when medically necessary
- **OhioRISE:** Inpatient psych routes to OhioRISE — ABA stays with Anthem

## How Anthem administers the benefit

Anthem's Ohio Medicaid Clinical UM Guidelines list confirms CG-BEH-02 (and CG-BEH-15 for activity therapy) as the adopted criteria for adaptive behavioral treatment, layered on the OAC 5160-34 baseline. No hour parameters (weekly ceiling, protocol-modification ratio) could be sourced to a current Anthem Ohio document, and the Ohio-specific published delta is thinner than at CareSource or Buckeye, so confirm hour rules with Anthem UM or the PA lookup tool at providers.anthem.com/oh before finalizing a request. UM submissions run through Availity Essentials' Interactive Care Reviewer, per the October 2025 provider manual, which also confirms the EPSDT framing and that under-21 inpatient psychiatric care routes to OhioRISE while ABA remains Anthem's responsibility. [1][2]

## Anthem Ohio Medicaid ABA claims: filing deadline, taxonomy, disputes and EVV

Filing deadline: “Providers will have 365 days to timely file a claim, including any timely filing exceptions, in accordance with Ohio Administrative Code (OAC) rule 5160-1-19”; when other insurance is primary, the clock runs from the primary plan’s explanation of payment. All claims are electronic. [2][6][7]

Taxonomy: claims must show the billing provider’s name, address and “taxonomy code, as certified with Ohio Medicaid,” and the rendering provider’s NPI and taxonomy code as certified with Ohio Medicaid; missing or invalid numbers “may result in nonpayment.” [2][6][7]

Disputes and appeals: a claim reconsideration filed more than 365 calendar days from the date of service or 60 calendar days from the EOP, whichever is later, is untimely. Utilization-management denials: reconsideration within 30 calendar days, peer-to-peer within 7, and a provider appeal within 60 calendar days of the initial determination. [2][6][7]

EVV does not apply to ABA in Ohio. OAC 5160-32-01 lists the services subject to Ohio’s EVV program — named waiver services in the home care, MyCare, PASSPORT and developmental-disability waivers, plus state-plan home health, private duty nursing and RN assessment and consultation — and makes managed care entities responsible for applying it; ABA is not on the list, and services delivered by telehealth are exempt. [2][6][7]

Payment clock: “Anthem will make every effort to finalize a clean electronic claim submission within 21 calendar days from the date the claim is received.” The contract floor behind that: ODM’s managed care provider agreement (Rev. 12/2025, App. L §10) requires every Ohio MCO — unless the MCO and the provider agreed an alternative payment schedule in the provider contract — to pay or deny 90% of clean claims within 21 calendar days of receipt, 99% within 60 calendar days and 100% of all claims within 90 calendar days; behavioral health claims are measured as their own category, and the standard applies to network and out-of-network providers alike. The same agreement requires the MCO to accept claims for 365 calendar days from the date of service under OAC 5160-1-19 (App. K §5a). Corrections Anthem requests must come back as a corrected claim through ODM’s fiscal intermediary within 365 days from the date of service, and when other insurance pays first the 365-day clock runs from the other carrier’s explanation of payment — Anthem needs the primary carrier’s remittance advice or denial letter with the claim. [2][6][7]

## Intake gates

The questions that decide whether a family can start with Anthem BCBS Ohio (Medicaid), and what they have to bring.

- **Age limit**: No state-level age bound could be verified, but Anthem’s Ohio Medicaid provider manual (10/2025) frames ASD services for members under 21 squarely under EPSDT: medically necessary services can exceed adult plan limits. Under-21 inpatient psychiatric care routes to OhioRISE while ABA remains Anthem’s responsibility. [3][1][2][2]
- **Who may diagnose**: Follows the Ohio Medicaid framework: the ASD diagnosis comes from a documented comprehensive diagnostic evaluation by a licensed physician, psychologist, or other clinician qualified to diagnose autism, demonstrating DSM-5-TR criteria. [3][1][2]
- **Referral required?**: No referral or service order requirement is published on the Medicaid side. Anthem adopts Clinical UM Guideline CG-BEH-02 (Adaptive Behavioral Treatment), with CG-BEH-15 for activity therapy, on top of the OAC 5160-34 baseline, and utilization-management requests run through Availity Essentials’ Interactive Care Reviewer. The assessment-versus-treatment PA split is not published — run the codes through the PA lookup tool at providers.anthem.com/oh per case. [3][1][2][1][2]
- **Prior-auth decision time**: Anthem’s Ohio Medicaid manual, citing OAC 5160-26-03.1 and R.C. 5160.34: “For non-urgent pre-service requests: 7 calendar days. For urgent pre-service requests: 48 hours,” both counted from receipt of the request. If Anthem decides a request marked urgent is not urgent, it becomes an elective request and the provider is told. No ABA reauthorization lead time is published. Ohio’s MCO rule sets the clock. For a standard request the MCO “must provide notice to the provider and member as expeditiously as the member’s health condition requires but no later than seven calendar days following receipt of the request for service,” extendable by up to fourteen calendar days (an MCO-requested extension needs ODM’s prior approval). An expedited decision is due “no later than forty-eight hours after receipt of the request for service” (OAC 5160-26-03.1, effective 1/1/2026). The 48 hours is stricter than the federal 72-hour managed-care cap. [2][11]
- **Other insurance (who pays first)**: Anthem is explicit that its own PA drops away on secondary claims: “No authorization is required for coordination of benefit (COB) claims.” Bill the primary carrier first, then send Anthem a claim for total billed charges with the primary carrier’s remittance advice, or a third-party letter explaining the denial. COB claims without one of these “will be mailed back.” Timely filing runs from the date of the other carrier’s explanation of payment (the manual’s table also says within 365 days of the date of service). Ohio’s MCO rule: “The MCE is the payer of last resort when a member has third party resources available.” Providers must “take reasonable measures to obtain all third party payments and file claims with all TPPs prior to billing the MCE.” That means a remittance from the other payer showing a valid non-payment reason (service not covered, applied to the deductible or copay, benefit maximum reached), a partial payment with its remittance, or no response within ninety days of submitting to the other payer. The MCO pays at most its allowed amount minus the other payments, and must allow at least ninety days from the other payer’s remittance to file. Exception: “The MCE, except SPBM, pays first for preventive pediatric services before seeking reimbursement from any liable third party.” Children in the custody of a county children’s services agency are exempt from TPL cooperation (OAC 5160-26-09.1). [2][12]
- **Telehealth** _(ask the plan)_: No plan-specific ABA telehealth rule found. ODM’s 2026 Telehealth Billing Guidelines (fee-for-service, under OAC 5160-1-18) list no ABA code — 97151–97158, 0362T, 0373T — as telehealth-eligible and do not name behavior analysts among eligible telehealth practitioners, while saying the MCOs “cover the same telehealth services as in fee-for-service but may have different billing requirements.” So remote assessment (97151) or supervision (97155) is not established in any document we could read for this plan; ask before scheduling it. [3][1][2][5]
  - Ask the plan: This plan’s provider portal or behavioral health UM line; Rules@Medicaid.Ohio.gov or JCARR for the in-force text of OAC 5160-34-02.

## Delivery and billing rules

Coverage decides whether Anthem BCBS Ohio (Medicaid) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Follows the Ohio framework (OAC 4783-6-02 COBA supervision plan, consultation before initiation and modification, periodic direct observation, no fixed ratio). No Anthem Ohio document we could read adds a protocol-modification or supervision ratio of its own, so none is stated here — confirm with Anthem UM before relying on any ratio. [3][1][2][1][4]
- **Daily limits / MUEs**: Anthem’s Ohio Medicaid provider manual (10/2025) publishes no ABA per-day unit table, and its Clinical UM Guidelines list only names CG-BEH-02 as the adopted criteria. The state rule it works under: ODM’s managed care provider agreement requires every MCO to “implement claims edits (e.g., … National Correct Coding Initiative [NCCI]) at the direction of ODM” (App. K §5c), and OAC 5160-1-19(B) has claims submitted pursuant to NCCI. The CMS Medicaid NCCI practitioner MUE table active 10/1–12/31/2026 sets 97151 at 32 units, 97152 at 16, 97153 at 32, 97154 at 18, 97155 at 24, 97156 at 16, 97157 at 16, 97158 at 16, 0362T at 16 and 0373T at 32 units per date of service. Those are claim edits; the weekly ceiling is whatever the prior authorization approves. [9][7][8]
- **Bill as provider**: Follows the Ohio Medicaid framework: independent practitioners are Certified Ohio Behavior Analysts (ORC Chapter 4783) or BACB BCBAs and BCBA-Ds enrolled with ODM as Provider Type 19, Specialty 190, with BCaBAs and RBTs delivering under supervision. The routing rule holds everywhere in Ohio: OhioRISE does not pay for ABA — ODM’s Mixed Services Protocol assigns ABA claims to the member’s MCO or fee-for-service even for OhioRISE-enrolled youth. [3][1][2]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: This plan’s provider portal or behavioral health UM line; Rules@Medicaid.Ohio.gov or JCARR for the in-force text of OAC 5160-34-02. [3][1][2]
- **Place of service** _(ask the plan)_: No plan-specific place-of-service rule found. The confirmed Ohio boundary is the school one: the MCO is not responsible for payment of services provided through the Medicaid School Program under OAC Chapter 5160-35, 5160-35-04 and 5160-26-03. [3][1][2]
  - Ask the plan: This plan’s provider portal or behavioral health UM line; Rules@Medicaid.Ohio.gov or JCARR for the in-force text of OAC 5160-34-02.

## What intake should collect for Anthem BCBS Ohio (Medicaid)

- **PA lookup check:** The assessment-vs-treatment PA split isn't published — run the codes through the lookup tool per case.
- **ASD diagnosis (DSM-5-TR):** Comprehensive evaluation per the state baseline.
- **Requested hours + justification:** Frame requested hours against severity and history; Anthem Ohio publishes no hour parameters of its own, so ask UM what it applies.
- **OhioRISE status:** Psychiatric services may route to OhioRISE, but ABA bills to Anthem — keep the paths straight.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Anthem BCBS Ohio (Medicaid) ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (pVerify):** 00759
- **Payer ID (Change Healthcare / Optum):** 0002937 — ODM FI MCE payer ID 0002937 (companion guide) — ABA claims ride the ODM FI to Anthem's medical payer ID, NOT a Carelon payer ID.
- **Supports 270/271 eligibility:** Yes
- **Real-time eligibility:** Yes
- **Behavioral health administrator:** Carelon Behavioral Health (utilization management / prior authorization ONLY — not a claims administrator)
- **ABA rides on:** medical benefit
- **Two-hop verification required:** Yes — Carelon is a UM/prior-authorization hop only (Carelon "provides utilization management services on behalf of the health plan"); ABA CLAIMS have no second hop — they route through the ODM FI to Anthem MCE payer ID 0002937. twoHopRequired=true reflects the authorization hop; there is NO separate BH claims payer ID.

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 32 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |
| 97152 | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 16 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |
| 97153 | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 32 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |
| 97154 | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 18 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |
| 97155 | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 24 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |
| 97156 | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 16 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |
| 97157 | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 16 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |
| 97158 | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 16 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |
| 0362T | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 16 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |
| 0373T | Yes — CG-BEH-02 (Adaptive Behavioral Treatment) adopted on the OAC 5160-34 baseline; EPSDT framing for under-21 members | Required — UM via Availity Essentials / Interactive Care Reviewer (per the 10/2025 provider manual). The assessment-vs-treatment PA split is not published — run codes through the PA lookup tool per case. | 32 units/day (CMS MUE ceiling; no Anthem Ohio Medicaid weekly or per-code cap could be sourced — verify in the PA lookup tool) per day | — | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Anthem's commercial CG-BEH-02 hour parameters could not be re-sourced to any Anthem Ohio Medicaid document, so none are stated here; the Ohio-specific published delta is thin and the cited GPP assets did not yield extractable per-code text this pass. Inpatient psychiatric care routes to OhioRISE; ABA stays with Anthem. Verify via: the current CG-BEH-02 guideline text (Carelon/Anthem clinical-guideline index) and the PA lookup at providers.anthem.com/oh.

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** 844-912-1226 — Anthem Ohio Medicaid Provider Services / automated Provider Inquiry Line (telephonic eligibility verification)
- **Portal:** [Availity Essentials / Interactive Care Reviewer](https://www.availity.com)

Questions to ask on a verification call:

- Is prior authorization the same process for assessment codes (97151/97152/0362T) as for treatment codes, or is there a separate assessment pathway?
- What POS codes are approved for ABA (home, school, clinic, telehealth)?
- Is telehealth allowed for ABA services, and what modifier/POS number applies?
- Does Anthem Ohio Medicaid apply any hours-per-week ceiling or per-code daily unit cap to ABA, and in which current guideline is it written?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Providers/MITS/HIPAA%205010%20Implementation/CompanionGuide/OMES/FFS/Ohio270-271.pdf (accessed 2026-07-23)
- https://www.carelonbehavioralhealth.com/content/dam/digital/carelon/cbh-assets/documents/oh/ohbcbs-cd-025424-23-carelon-bh-intgrtn-qrg.pdf (accessed 2026-07-23)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://providers.anthem.com/docs/gpp/OH_CAID_FEB23CUMG.pdf (accessed 2026-07-23)
- https://providers.anthem.com/docs/gpp/OH_CAID_ProviderManual.pdf (accessed 2026-07-23)

## Common questions

### Does Anthem Ohio Medicaid cover ABA therapy?

Yes — under its adopted CG-BEH-02 adaptive behavioral treatment guideline on top of OAC 5160-34, submitted via Availity's Interactive Care Reviewer, with EPSDT protections for under-21 members.

### Does OhioRISE change anything for Anthem ABA members?

Inpatient psychiatric care for under-21s routes to OhioRISE, but ABA always stays with Anthem (per ODM's mixed-services protocol) — bill the MCO, not OhioRISE.

### Does Anthem Ohio Medicaid require taxonomy on ABA claims?

Yes. Show the billing and rendering providers’ taxonomy codes as certified with Ohio Medicaid; missing or invalid numbers may result in nonpayment (Anthem Ohio Medicaid provider manual).

### How fast does Anthem Ohio Medicaid pay a clean ABA claim?

Anthem says it makes every effort to finalize a clean electronic claim within 21 calendar days of receipt; ODM’s MCO contract requires 90% of clean claims within 21 calendar days, 99% within 60 and all claims within 90, unless your provider contract sets another schedule. Secondary (COB) claims are due within 365 days counted from the primary carrier’s explanation of payment.

## Primary sources

1. [Anthem OH Medicaid — Clinical UM Guidelines list](https://providers.anthem.com/docs/gpp/OH_CAID_FEB23CUMG.pdf)
2. [Anthem OH Medicaid — provider manual (10/2025)](https://providers.anthem.com/docs/gpp/OH_CAID_ProviderManual.pdf)
3. [Ohio Administrative Code — rule 5160-34-02](https://codes.ohio.gov/ohio-administrative-code/rule-5160-34-02)
4. [Ohio Administrative Code — rule 4783-6-02 (COBA supervision responsibilities)](https://www.law.cornell.edu/regulations/ohio/Ohio-Admin-Code-4783-6-02)
5. [ODM — Telehealth Billing Guidelines (FFS, DOS on or after 1/1/2026)](https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Providers/Billing/BillingInstructions/Telehealth_Billing_Guidelines_updates_for_2026_final.pdf)
6. [OAC 5160-32-01 — Electronic visit verification: programs and services subject to EVV, codes.ohio.gov](https://codes.ohio.gov/ohio-administrative-code/rule-5160-32-01)
7. [ODM — Ohio Medicaid Provider Agreement for Managed Care Organization (Rev. 12/2025): App. K §5 claims, App. L §10 prompt pay](https://dam.assets.ohio.gov/image/upload/medicaid.ohio.gov/Providers/ProviderTypes/Managed%20Care/Provider%20Agreements/2025_12_MCO_Final.pdf)
8. [CMS — Medicaid NCCI MUE edits, practitioner services (2026 Q4, active 10/1–12/31/2026)](https://www.cms.gov/files/zip/medicaid-ncci-2026-q4-mue-edits-practitioner-services.zip)
9. [OAC 5160-1-19 — Submission of medicaid claims (eff. 2/1/2023), codes.ohio.gov](https://codes.ohio.gov/ohio-administrative-code/rule-5160-1-19)
10. [Anthem Ohio — Provider News (index of articles and monthly newsletters, Medicaid and commercial)](https://providernews.anthem.com/ohio)
11. [OAC 5160-26-03.1 — MCO utilization management and authorization timeframes (eff. 1/1/2026)](https://codes.ohio.gov/ohio-administrative-code/rule-5160-26-03.1)
12. [OAC 5160-26-09.1 — MCO third party recovery and coordination of benefits](https://codes.ohio.gov/ohio-administrative-code/rule-5160-26-09.1)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.