MedicaidPrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·OH · Cardiology, Cardiothoracic Surgery, Critical Care·Provider Bulletin
Effective date
Jul 1, 2026
We identified it
May 27, 2026
Summary
Effective July 1, 2026, four new cardiovascular CPT codes (C7568, C7569, C7570, C7571) related to coronary angiography and angioplasty procedures now require precertification/prior authorization through Carelon Medical Benefits Management for Ohio Medicaid beneficiaries. Providers must obtain authorization before performing these procedures or face potential claim denials.
Action Required
By June 30, 2026: Billing team and providers must implement prior authorization requirement for CPT codes C7568, C7569, C7570, and C7571. Update billing software, EMR templates, and charge capture systems to flag these codes as requiring Carelon Medical Benefits Management precertification before claim submission. Providers must submit authorization requests via the Carelon provider portal (https://providerportal.com) or Availity Essentials (https://Availity.com) for all Ohio Medicaid patients scheduled for these coronary procedures. Designate staff to monitor for authorization status before scheduling or performing procedures. Claims submitted without prior authorization will be denied.