Medicare AdvantagePrior AuthMedium impact
[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (June 2026 Newsletter)
Anthem BCBS·CA · Sleep Medicine, Cardiology, Radiation Oncology +2 more·Provider Bulletin
Effective date
Sep 1, 2026
We identified it
May 28, 2026
Summary
Carelon Medical Benefits Management has updated prior authorization requirements for Medicare Advantage plans effective September 1, 2026, across six clinical areas: Sleep, Cardiovascular, Radiation Oncology, Radiology, and Genetic Testing. The billing team must identify which services in these specialties now require precertification and update workflow processes accordingly.
Action Required
By August 15, 2026: Billing team must obtain the detailed precertification requirement updates for Sleep, Cardiovascular, Radiation Oncology, Radiology, and Genetic Testing services from the full policy documents linked in the bulletin (available at https://providernews.anthem.com/california/articles/precertificationprior-authorization-requirement-updates-care-30265). Once specific codes and requirements are identified, update the billing system to enforce prior authorization workflows for affected services. Communicate changes to clinical staff and front desk to ensure authorization requests are submitted before services are delivered. Failure to obtain required prior authorization will result in claim denials for Medicare Advantage patients.