All PlansPrior AuthMedium impact
[New York] Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines effective
Anthem BCBS·NY·Provider Bulletin
We identified it
Jun 13, 2026
Summary
Carelon Medical Benefits Management has updated their Clinical Appropriateness Guidelines for New York providers. This affects medical necessity determinations and prior authorization requirements for services managed by Carelon.
Action Required
Immediately: Review the updated Carelon Clinical Appropriateness Guidelines at the provided URL to identify changes to prior authorization requirements and medical necessity criteria. Update internal protocols and staff training accordingly to ensure compliance with new guidelines.