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Anthem BCBSCommercial · Prior Auth · Provider Bulletin · GA · OB-GYN, GeneticsMedium impact

[Georgia] Prior authorization requirement updates — Carelon Medical Benefits Management

Act
by Sep 15, 2026
Effective date
Oct 1, 2026
Identified
May 27, 2026

Summary

Effective October 1, 2026, CPT code 0253U (reproductive medicine endometrial receptivity analysis) will require prior authorization/precertification through Carelon Medical Benefits Management for commercial plans in Georgia. Billing teams must implement this requirement in their authorization workflows and direct providers to submit requests through the Carelon provider portal or Availity.

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What to do

by Sep 15, 2026 · 8 steps
01Billing team must update authorization protocols to require prior authorization for CPT code 0253U for all Georgia commercial plan members.
02Configure billing system to flag claims for this code and route to authorization queue before submission.
03Notify ordering and servicing providers that precertification requests must be submitted to Carelon Medical Benefits Management via.
04Carelon provider portal at https://providerportal.com (24/7 online access, fastest method).
05Availity Essentials at https://Availity.com.
06Claims submitted without prior authorization will be denied.
07Direct provider questions about authorization guidelines to MedicalBenefitsManagement.guidelines@Carelon.com.
08Reference UM AROW #A2026M5374 when requesting authorization.

Original notice

[Georgia] Prior authorization requirement updates — Carelon Medical Benefits Management
providernews.anthem.com · Always check the source before changing claims.
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Related changes

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[Georgia] Prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Oct 1, 2026 · Provider Bulletin[New York] Prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Oct 1, 2026 · Provider Bulletin[Virginia] Prior authorization requirement updates — Carelon Medical Benefits ManagementMediumEffective Oct 1, 2026 · Provider BulletinBrowse every Anthem BCBS change in the policy list

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