[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

By October 31, 2026: Billing team and providers must implement prior authorization requirement for CPT 0600U in all systems and workflows. (1) Update billing software to flag CPT 0600U as requiring prior authorization before claim submission; (2) Configure encounter forms and order entry systems to prompt providers to obtain precertification before ordering this test; (3) Train ordering providers and lab staff that this code now requires Carelon precertification; (4) Establish process for submitting authorization requests through Carelon Medical Benefits Management provider portal (https://providerportal.com), Availity Essentials (https://Availity.com), or email (MedicalBenefitsManagement.guidelines@Carelon.com). For questions on authorization guidelines, contact Carelon at the provided email. Failure to obtain prior authorization will result in claim denials for affected Anthem Blue Cross and Blue Shield commercial members in New York.