What types of policy changes does Anthem BCBS issue?

Anthem BCBS regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Anthem BCBS update its policies?

Anthem BCBS typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Anthem BCBS policy changes are tracked here?

This page currently tracks 50 documented Anthem BCBS policy changes. New items are added as they are identified.

What should I do when Anthem BCBS changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Anthem BCBS Policy Changes 2026 | Prior Auth & Coverage Updates

Anthem BCBS Policy Changes & Prior Auth Updates

We track 50 documented policy changes from Anthem BCBS across AL, AR, CA, CO, CT and 5 more states. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Anthem BCBS notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Anthem BCBS updates automatically.

High impact

[Ohio] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

Anthem BCBS·Effective Sep 19, 2026

Carelon Medical Benefits Management has updated clinical appropriateness guidelines effective September 19, 2026, with expansions and modifications across radiology, cardiology, and vascular imaging. Key changes include expanded CT indications for brain perfusion, new vascular imaging criteria (particularly for CTA/MRA), relaxed requirements for some orthopedic imaging (meniscal tears, TFCC instability), modified cardiac device criteria (expanded wearable cardioverter defibrillators and dual-chamber leadless pacemakers), and removal of certain PCI criteria based on recent clinical evidence. Billing teams must review updated approval criteria for imaging and cardiac procedures to ensure proper prior authorization and claims submission.

[Georgia] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[Virginia] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[Ohio] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[Ohio] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[New York] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[New York] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[California] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective

[Virginia] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines

[Ohio] Clinical Criteria updates

[California] Clinical Criteria updates

[New York] Clinical Criteria updates

[Virginia] Clinical Criteria updates

[Georgia] Clinical Criteria updates

[New York] Medical Policies and Clinical Utilization Management Guidelines update

[Virginia] Medical Policies and Clinical Utilization Management Guidelines update

[Georgia] Medical Policies and Clinical Utilization Management Guidelines update

[California] Medical Policies and Clinical Utilization Management Guidelines update

[California] Review Excludes1 Notes to help keep claims on track

[Ohio] Review Excludes1 Notes to help keep claims on track

[Virginia] Review Excludes1 Notes to help keep claims on track

[Georgia] Review Excludes1 Notes to help keep claims on track

[New York] Clinical Criteria updates

[California] Clinical Criteria updates

[New York] Clinical Criteria updates

[New York] Prior authorization and step therapy updates for medications billed under the medical benefit

[Virginia] Clinical Criteria updates

[Georgia] Clinical Criteria updates

[California] Use modifier 25 when billing eligible E&M services with XXX procedures

[New York] Use modifier 25 when billing eligible E&M services with XXX procedures

[New York] Updated claims editing process for outpatient facility claims

[Ohio] Prior authorization and step therapy updates for medications billed under the medical benefit

[Ohio] Take action: Use no-cost electronic claims to avoid paper administrative fees

[Georgia] Take action: Use no-cost electronic claims and payments to avoid paper administrative fees

[California] August 2026 Provider Newsletter

[California] Take action: Use no-cost electronic claims and payments to avoid paper administrative fees

[New York] Take action: Use no-cost electronic claims and payments to avoid paper administrative fees

[Virginia] Take action: Use no-cost electronic claims and payments to avoid paper administrative fees

[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (August 2026 Newsletter)

[New York] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility

[New York] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

[Ohio] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility

[Ohio] Behavioral Health Prior Authorization Requirements - Substance use disorder (SUD) services and levels of care (LOC)

[Georgia] Reimbursement policy reminder: Provider Preventable Conditions — Professional and Facility

[Georgia] Reimbursement policy update: Facility Guidelines for Claims Related to Professional Services — Facility

[New York] Medical Policy and Clinical Guideline updates effective

[New York] Specialty pharmacy updates — July 2026

[Virginia] Specialty pharmacy updates — July 2026

[California] Clinical Criteria updates

[California] Critical Care to Home: what care providers need to know

[California] Clinical Criteria updates