CommercialPrior AuthMedium impact
[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management
Anthem BCBS·GA · Infectious Disease, Wound Care, General Surgery·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Jul 1, 2026
Summary
Effective November 1, 2026, Anthem Blue Cross and Blue Shield in Georgia is adding CPT code 0600U (infectious disease wound infection testing) to the list of services requiring precertification/prior authorization through Carelon Medical Benefits Management. Providers must obtain prior authorization before performing this genetic/molecular testing or claims will be denied.
Action Required
By October 15, 2026: Billing team must update all systems and workflows to require prior authorization for CPT code 0600U before claims submission. (1) Update billing software to flag 0600U for Carelon prior auth requirement; (2) Notify all ordering providers and wound care staff that 0600U now requires precertification; (3) Add 0600U to encounter forms and EHR templates with a reminder to obtain authorization; (4) Train front desk staff to prompt providers about prior auth at time of order. Providers should submit authorization requests via Carelon's provider portal at https://providerportal.com (24/7 access recommended) or via Availity Essentials at https://Availity.com. Claims submitted without prior authorization will be denied by Anthem.