MedicaidAdministrativeLow impact
[New York] Utilization management: prioritizing appropriate care and transparency
Anthem BCBS·NY·Prior Authorization
Effective date
May 20, 2026
We identified it
May 21, 2026
Summary
Anthem Blue Cross has published updated utilization management (UM) guidance for New York Medicaid clarifying the prior authorization submission process, support resources, and UM decision-making standards. The policy reinforces existing submission methods (Availity, fax, phone) and 24/7 preapproval availability, with no substantive changes to billing workflows or authorization requirements.
Action Required
No immediate action required. This is informational guidance reiterating existing UM processes for Anthem Blue Cross New York Medicaid. Billing team should note: (1) Prior authorization requests can be submitted via Availity Essentials, fax to 800-964-3627, or phone to 800-450-8753; (2) Clinical staff available 24/7 for preapprovals with callback within one business day; (3) UM decisions based on appropriateness of care and coverage, not financial incentives. Staff should familiarize themselves with the updated Provider Services contact number (800-450-8753) and Availity portal access for authorization tracking. No changes to current billing procedures or claim submission processes are required.