Medicare AdvantagePrior AuthMedium impact
[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management (July 2026 Newsletter)
Anthem BCBS·OH · Oncology, OB-GYN, Neurology +3 more·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Jun 17, 2026
Summary
Anthem Blue Cross and Blue Shield has updated precertification and prior authorization requirements through Carelon Medical Benefits Management, specifically affecting genetic testing services. The changes apply to both Medicare Advantage and Medicaid plans in Ohio.
Action Required
Before October 1, 2026: Billing team must review and implement new prior authorization requirements for genetic testing services through Carelon Medical Benefits Management. Update billing system workflows to ensure proper precertification is obtained for genetic testing procedures for Medicare Advantage and Medicaid patients. Visit the provided URL for complete details on specific requirements.