Claims overview

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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, visit our Claims Submissions and Disputes page or refer to your provider manual .

Claims services through Availity Essentials

You can use Availity Essentials to submit and check the status of all your claims, prior authorizations, payments, dispute a claim, and much more at https://www.availity.com .

Don’t have an Availity Essentials account?

More resources

Electronic data interchange (EDI)

Electronic data interchange (EDI) is the computer-to-computer exchange of business documents in a structured format. EDI provides a faster and cleaner method for delivering time-dependent data, saving you time compared to filing paper claims.

Provider 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.

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.

Reimbursement policies

Policies outlining the basic terms for reimbursement of services covered under our members’ benefits plans and definitions for terms used in the policies and disclaimer for the policies’ use can be found here.

Provider tools & resources

Join our network

We’re glad you’re interested in joining the Anthem network. We have a diverse network of exceptional healthcare professionals who ensure our members have uninterrupted access to the support they need.