[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (June 2026 Newsletter)

By June 15, 2026: Billing team must obtain detailed policy documents from Carelon Medical Benefits Management for each affected service category and plan type. Update billing system rules to require prior authorization for all affected procedures in Genetic Testing, Sleep, Cardiovascular, Musculoskeletal, Radiology, and Radiation Oncology services according to the staggered effective dates (July 1 for Medicaid, September 1 for Medicare Advantage, October 1 for Commercial). Before each effective date, notify providers and front-desk staff of new prior authorization requirements for their respective specialties. Verify that the retracted Cardiovascular Commercial policy (retracted July 17, 2026) is removed from all billing workflows. Configure system alerts to enforce prior authorization submission before claim submission for each plan type, as claims without proper prior authorization will be denied.