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[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (June 2026 Newsletter)
Act
by Aug 1, 2026
Effective date
Sep 1, 2026
Identified
May 28, 2026
Summary
Carelon Medical Benefits Management has updated prior authorization and precertification requirements across multiple service categories effective September 1, 2026 (Medicare Advantage) and October 1, 2026 (Commercial). Changes affect cardiovascular, genetic testing, sleep medicine, radiation oncology, radiology, musculoskeletal, and other specialties. Note: One cardiovascular policy was retracted on July 17, 2026.
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What to do
by Aug 1, 2026 · 6 steps
01Billing team must obtain detailed policy specifications from Carelon for each affected service category (cardiovascular, genetic testing, sleep medicine, radiation oncology, radiology, musculoskeletal) to identify which specific CPT/HCPCS codes now require prior authorization.
02Update billing system and EMR templates to enforce new prior authorization workflows for Medicare Advantage plans.
03By September 15, 2026: Repeat process for Commercial plans with October 1, 2026 effective date.
04Notify providers of new authorization requirements by specialty.
05Train front desk and prior authorization staff on procedures.
06Alert clinical staff to include authorization requests in care planning.
If missed: Failure to obtain required prior authorizations will result in claim denials and payment delays.
Original notice
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (June 2026 Newsletter)
providernews.anthem.com · Always check the source before changing claims.
Related changes
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