Medicare AdvantagePrior AuthHigh impact
[New York] June 2026 Provider Newsletter
Anthem BCBS·NY·Newsletter
Effective date
Jul 1, 2026
We identified it
Jun 2, 2026
Summary
Anthem's June 2026 New York newsletter consolidates multiple policy updates effective across July-September 2026, including prior authorization requirement changes for parenteral nutrition codes (Medicare Advantage effective July 1), new prior auth changes for Medicare Advantage and Medicaid (effective September 1), pharmacy prior authorization and step therapy updates for medical benefit medications (Medicaid effective July 1), clinical criteria updates, and administrative changes to billing accuracy requirements (effective July 17, 2026 across all plans). Billing teams must systematically update systems and workflows for each affected plan type and effective date.
Action Required
By June 1, 2026 (immediately upon newsletter receipt): Billing team must obtain detailed specifications from Anthem for (1) parenteral nutrition codes requiring new precertification/prior authorization effective July 1, 2026 (Medicare Advantage), (2) all codes affected by prior authorization requirement changes effective September 1, 2026 (Medicare Advantage and Medicaid), and (3) all medications under medical benefit requiring new/updated prior authorization and step therapy effective July 1, 2026 (Medicaid). Before July 1, 2026: Update billing system rules and encounter forms to automatically trigger prior authorization workflows for affected codes and medications by plan type. Before July 17, 2026: Implement auditing procedures to ensure billed charges and units are accurate on all professional claims per the May 15, 2026 administrative reminder, as claims may be denied or delayed due to billing accuracy issues. By September 1, 2026: All Medicare Advantage and Medicaid prior authorization requirement changes must be fully operational. Contact Anthem Provider Services at https://providernews.anthem.com/new-york/ to obtain specific code lists and implementation guidance. Failure to obtain required prior authorizations will result in claim denials.