By July 15, 2026: Billing team and providers must obtain copies of the 21 new clinical criteria documents (CC-0027, CC-0029, CC-0033, CC-0108, CC-0109, CC-0112, CC-0115, CC-0118, CC-0121, CC-0123, CC-0125, CC-0135, CC-0157, CC-0158, CC-0170, CC-0186, CC-0201, CC-0232, CC-0281) from Anthem's medical necessity review guidelines. Update prior authorization submission protocols in billing software to require clinical criteria compliance documentation. Before August 1, 2026: Train all clinical and billing staff on the new criteria for denosumab, dupilumab, omalizumab, eribulin, ziv-aflibercept, radium Ra 223 dichloride, ado-trastuzumab, radioimmunotherapy agents, obinutuzumab, ramucirumab, nivolumab, melanoma vaccines, enfortumab vedotin, fam-trastuzumab deruxtecan, inebilizumab, margetuximab, amivantamab products, mosunetuzumab, and nivolumab hyaluronidase products. Notify prescribing providers that prior authorization submission must now include documentation supporting the new clinical criteria or claims will be denied as not medically necessary. Update encounter templates to capture medical necessity elements aligned with new criteria. Establish verification workflow: billing team must confirm each specialty pharmacy claim meets the applicable clinical criteria before transmission to avoid denials.