Claims overview
File claims simply and easily.
Submitting claims and prior authorizations
Providers are required to submit claims, prior authorizations, and associated attachments through Availity Essentials* or using electronic data interchange (EDI) through an Ohio Department of Medicaid (ODM) authorized trading partner. For more information about submitting claims and prior authorizations, utilize the resources in this section or refer to your provider manual.
Claims and Availity
You can use Availity Essentials to submit and check the status of all your claims, prior authorizations, payments, dispute a claim, and much more.
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Claims resources
Claims submissions and disputes
You have the right to request an appeal of a claim decision. You may request this appeal on your own behalf or on behalf of a covered member.
Reimbursement policies
These policies outline the basic terms for reimbursement of services covered under our members’ benefits plans.
Electronic data interchange (EDI)
Anthem providers may submit claims, inquiries, and associated attachments using EDI through an authorized ODM trading partner.
Claims Payment Systemic Error (CPSE) report
A CPSE is defined as a systematic incident causing claims to adjudicate incorrectly, which could result in underpaying, overpaying, denying, or suspending claims. When this occurs and impacts five or more providers, or has the potential to impact five or more providers, Anthem will report CPSE data on our Ohio Medicaid provider website. Before submitting a complaint, providers should check the plan’s Claims Payment Systemic Errors (CPSE) report for the issue in question.
Anthem Blue Cross and Blue Shield CPSE Log November 2025
Anthem Blue Cross and Blue Shield CPSE Log October 2025
Anthem Blue Cross and Blue Shield CPSE Log September 2025
Anthem Blue Cross and Blue Shield CPSE Log August 2025
Anthem Blue Cross and Blue Shield CPSE Log July 2025
Electronic visit verification (EVV)
Electronic visit verification (EVV) is used by caregivers for some home and community-based services to document the time services begin and end. The Ohio Department of Medicaid provides an EVV system at no cost to all providers.
For more information on electronic visit verification (EVV) please visit the Ohio Department of Medicaid (ODM) EVV Homepage.
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We look forward to working with you to provide quality service for our members.